Previous reports have demonstrated that treatment efficacy is not modified by age and that there are no major differences in outcomes among stage-matched patients as their ages increase. However, there seems to be a substantial undertreatment in the elderly.

We reviewed consecutive patients with breast cancer, 60 years old or older, between July 2003 and March 2007. Patient characteristics, clinicopathologic factors and treatment delivery were retrieved from medical records. Patients were subdivided into two groups (mid-elderly, 60–74 years old and high-elderly, 75 years old or older) and compared based on these factors.

A total of 280 patients were included. All were female. Sixteen percent were high-elderly. Most patients had favorable performance status (0/1, 87%), positive estrogen receptor (57%), negative human epidermal growth factor receptor 2 overexpression (65%) and axillary lymph node metastases (57%). The high-elderly group had significantly less human epidermal growth factor receptor 2 overexpression and less axillary lymph node metastasis. Chemotherapy was administered to 180 patients, and among them, those in the high-elderly group underwent significantly less chemotherapy (P < 0.001). Both anthracycline and taxane were significantly less frequently administered in high-elderly (P < 0.001, respectively). An alternative regimen for anthracycline and taxane was mainly a 5-fluorouracil-based single agent. Chemotherapy was omitted in 12 patients (3 mid-elderly and 9 high-elderly) because of age, and in 9 patients, age was the only reason for omitting chemotherapy.

We confirmed that elderly patients were substantially undertreated. The development of a safer and more efficacious treatment strategy is urgently needed.