Controversies of radiation therapy omission in elderly women with early stage invasive breast cancer

Breast cancer remains the most commonly diagnosed non-cutaneous cancer in women (1). Increasing age remains one of the most important risk factors for develop breast cancer (2). Therefore, according to the American Cancer Society, 1 in 25 women of age 70 will likely developing invasive breast cancer compared to 1 in 43 for patients 50 years of age (3). The prevalence of breast cancer in elderly population is expected to increase as the average life expectancy of the population is tending to increase; reaching 81 years for women in the United States (4). Adjuvant radiation therapy after breast conserving surgery is currently considered the standard accepted treatment approach for patients with early stage invasive breast cancer (5). Elderly women population, on the other hand, remains under-represented in many trials. There have been several studies and trials attempting to address the radiation question, specifically in the elderly population. This review aims to analyze published data to provide clinicians with a general oversight on how to approach this question in real life scenarios