乳腺癌的发病率随着年龄的增长而增加。特别是在老龄化社会中，乳腺癌对老年患者和医疗保健系统都有重大影响。在老年早期乳腺癌患者中，(i) 肿瘤生物学、(ii) 复发风险、(iii) 合并症、(iv) 虚弱、(v) 预期寿命和 (vi) 患者期望和偏好之间存在复杂的相互作用。我们的治疗指南通常基于大型荟萃分析，这些分析表明（新）辅助化疗总体上可以提高早期乳腺癌的生存率。这对于三阴性和 HER2 阳性乳腺癌尤其重要，但复发风险较高的激素受体 (HR) 阳性、HER2 阴性患者也能从化疗中受益。然而，大多数研究都包括年轻且经过精心挑选的患者。由于年龄与雌激素受体状态之间以及年龄与伴随疾病的数量以及化疗的耐受性之间存在正相关性，因此评估额外（新）辅助化疗的效果非常重要，特别是在老年患者中早期乳腺癌患者。只有少数研究仅纳入患有早期乳腺癌的老年患者。总体而言，他们表明，患有 HR 阳性、HER2 阴性肿瘤的老年患者除了内分泌治疗外，几乎无法从化疗中获益。对于这些患者，在权衡潜在的益处和危害时，应谨慎考虑额外的化疗。然而，这种关键性评估不应与放弃标准化疗相混淆，前提是标准化疗是可行的，并且根据老年评估、风险评估和患者偏好有临床指征。我们的叙述性综述的目的是提供关于老年乳腺癌女性化疗的证据的简明概述，并将其置于老年 HR 阳性、HER2 阴性早期乳腺癌患者的老年评估和风险评估的背景下。这反过来应该有助于批判性地权衡个体老年早期乳腺癌患者化疗的风险和益处，这最终应该导致更加个体化、同时更加基于证据的治疗建议，考虑到不同且有时相互矛盾的患者和肿瘤特异性因素之间复杂的相互作用。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

The incidence of breast cancer increases with age. Particularly in ageing societies, breast cancer has a significant impact on both the older patient and the healthcare system. In older patients with early breast cancer, there is a complex interplay between (i) tumor biology, (ii) risk of recurrence, (iii) comorbidities, (iv) frailty, (v) life expectancy and (vi) patient expectations and preferences. Our treatment guidelines are often based on large meta-analyses that have shown that (neo)adjuvant chemotherapy improves the survival rate in early breast cancer in general. This is particularly important in triple-negative and HER2-positive breast cancer, but hormone receptor (HR)-positive, HER2-negative patients with a higher risk of recurrence also benefit from chemotherapy. However, most studies included younger and carefully selected patients. Since there is a positive correlation between age and estrogen receptor status, as well as between age and the number of concomitant diseases and the tolerability of chemotherapy, it is of great importance to evaluate the effects of additional (neo)adjuvant chemotherapy, especially in older patients with early-stage breast cancer. There are only a few studies in which only older patients with early breast cancer were included. On the whole, they show that older patients with HR-positive, HER2-negative tumors hardly benefit from chemotherapy in addition to endocrine therapy. In these patients, additional chemotherapy should be considered critically when weighing up the potential benefits and harms. However, this critical evaluation should not be confused with abandoning standard chemotherapy when it is feasible and clinically indicated based on geriatric assessment, risk assessment, and patient preference. The aim of our narrative review is to provide a concise overview of the evidence on chemotherapy in older women with breast cancer and place it in the context of geriatric assessment and risk evaluation in older HR-positive, HER2-negative patients with early breast cancer. This in turn should help to critically weigh up the risks and benefits of chemotherapy for the individual older patient with early-stage breast cancer, which should ultimately lead to more individualized and at the same time more evidence-based treatment recommendations that take into account the complex interplay of different and sometimes contradictory patient- and tumor-specific factors.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.