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Giraudo A, Sabatier R, Rousseau F, De Nonneville A, Gonçalves A, Cecile M, Braticevic C, Viret F, Seguin L, Kfoury M, Naudet D, Hamon M, Tassy L. The Use of Cyclin-Dependent Kinase 4/6 Inhibitors in Elderly Breast Cancer Patients: What Do We Know? Cancers (Basel) 2024; 16:1838. [PMID: 38791919 PMCID: PMC11119337 DOI: 10.3390/cancers16101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Breast cancer (BC) incidence increases with age, particularly in HR-positive/HER2-negative subtypes. Cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6is) alongside endocrine therapy (ET) have emerged as promising treatments for HR-positive/HER2-negative advanced and early BC. However, their efficacy, safety, and impact on quality of life (QoL) in older and frail patients remain underexplored. METHODS This position paper assesses the existing literature from 2015 to 2024, focusing on CDK4/6is use in patients aged 65 years and older with HR-positive/HER2-negative BC. RESULTS Our analysis methodically addresses critical questions regarding the utilization of CDK4/6is in the elderly BC patient population, organizing findings from the metastatic and adjuvant settings. In the metastatic setting, CDK4/6is significantly improve progression-free survival (PFS), paralleling benefits observed in younger patients, and suggest potential overall survival (OS) benefits, warranting further investigation. Despite an increased incidence of grade ≥ 3 adverse events (AEs), such as neutropenia and asthenia, CDK4/6is present a markedly lower toxicity profile compared to traditional chemotherapy, with manageable side effects. QoL analysis indicates that integrating CDK4/6is into treatment regimens does not significantly impact elderly BC patients' daily life and symptom management. Special attention is given to frail subgroups, and personalized approaches are recommended to balance efficacy and adverse effects, such as starting with ET alone and introducing CDK4/6is upon progression in patients with a low disease burden. Transitioning to the adjuvant setting, early results, particularly with abemaciclib, indicate positive effects on disease-free survival (DFS), emphasizing the need for continued analysis to validate these findings and assess long-term implications. However, data on older patients are insufficient to conclude whether they truly benefit from this treatment. CONCLUSION Overall, CDK4/6is present a favorable benefit-risk profile in older BC patients, at least in advanced BC; however, further research is warranted to optimize treatment strategies and improve outcomes in this population.
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Affiliation(s)
- Alexandre Giraudo
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Renaud Sabatier
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Frederique Rousseau
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Alexandre De Nonneville
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Anthony Gonçalves
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Maud Cecile
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Cecile Braticevic
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Frederic Viret
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Lorene Seguin
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Maria Kfoury
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Dorothée Naudet
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
| | - Marie Hamon
- Medical School Department, Aix-Marseille Université, 13005 Marseille, France;
| | - Louis Tassy
- Institute Paoli-Calmette, 13009 Marseille, France; (R.S.); (F.R.); (A.D.N.); (A.G.); (M.C.); (C.B.); (F.V.); (L.S.); (M.K.); (D.N.)
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Paik HJ, Kim SJ, Kim KS, Kim Y, Lee SK, Kang SH, Joon J, Youn HJ. Characteristics and chronologically changing patterns of late-onset breast cancer in Korean women of age ≥ 70 years: A hospital based-registry study. BMC Cancer 2022; 22:1261. [PMID: 36471272 PMCID: PMC9720951 DOI: 10.1186/s12885-022-10295-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/08/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Women from Asian and western countries have vastly different ages of onset of breast cancer, with the disease tending to occur at an older age in the West. Through an investigation of the patterns of old-onset breast cancer (OBC) in Korean women, we aimed to identify the characteristics of Korean OBC and evaluate whether these patterns are changing in relation to increasing westernization. METHODS This study retrospectively evaluated 102,379 patients who underwent surgical treatment of primary breast cancer between January 1, 2000 and December 31, 2013 in Korea. We used hospital -based breast cancer registry and analyzed data from these patients using multiple linear regression analysis to compare the characteristics and chronologically changing patterns between OBC (70 years of age or older) and non-OBC (40-69 years of age) patients in Korea. RESULTS A total of 6% of the 102,379 patients had OBC. Overall, OBC had more favorable biological features, such as a higher incidence of luminal A subtype, than did non-OBC, except for a higher incidence rate of triple-negative breast cancer (TNBC). However, OBC also presented with a higher overall disease stage, including higher T and M stages. Although the incidence rates of both OBC and non-OBC have increased overtime, the relative proportion of OBC patients has slightly increased, whereas that of non-OBC has slightly decreased. The increase in the incidence of both OBC and non-OBC was primarily due to the luminal A subtype. CONCLUSIONS Based on a hospital-based registry, overall, Korean OBC had favorable biological features but showed a higher rate of TNBC and advanced cancer stages. The incidence trend of breast cancer in Korea is slowly shifting toward an older age at onset, largely due to the luminal A subtype. Our results may provide novel insights into OBC in Asia, and aid in the development of optimal management of the disease in Asia. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Hyun-June Paik
- grid.412591.a0000 0004 0442 9883Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Suk Jung Kim
- grid.411612.10000 0004 0470 5112Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 612-030 South Korea
| | - Ku Sang Kim
- grid.411145.40000 0004 0647 1110Department of Breast-Endocrine Surgery, Kosin University Gospel Hospital, Busan, South Korea
| | - Yongsuk Kim
- grid.411947.e0000 0004 0470 4224Department of Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, South Korea
| | - Se Kyung Lee
- grid.414964.a0000 0001 0640 5613Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Su Hwan Kang
- grid.413028.c0000 0001 0674 4447Department of Surgery, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jeong Joon
- grid.15444.300000 0004 0470 5454Department of Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyun Jo Youn
- grid.411545.00000 0004 0470 4320Department of Surgery, Chonbuk National University Medical School, Jeonju, South Korea
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3
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Kim SJ, Park YM. Breast cancer in elderly Korean women: clinicopathological and biological features. Breast Dis 2021; 39:71-83. [PMID: 32250285 DOI: 10.3233/bd-190422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND With an aging society, Korean women ≥70 years of age are increasingly being diagnosed with breast cancer. OBJECTIVE To investigate the clinicopathological and biological characteristics of breast cancer in elderly Korean women and compare them with breast cancer in elderly (≥70 years) women globally and in Korean women of all ages. METHODS We retrospectively reviewed the clinicopathological and biological features of breast cancer in elderly Korean women (≥70 years; n = 87) who sought treatment during 2004-2014 from a single institution. These data were indirectly compared with data of Korean women of all ages (nationwide Korean Breast Cancer Registry) or elderly women globally (meta-analysis). RESULTS Compared to elderly women with breast cancer globally, Korean elderly women had a more symptomatic presentation, lower ER expression, and overexpression or amplification of human epidermal growth factor receptor 2. Compared to Korean women of all ages with breast cancer, elderly Korean women presented with advanced tumor stages, larger tumor size, more lymph node involvement, and more luminal B and basal-like subtypes. CONCLUSIONS Breast cancer had a more aggressive clinicopathological and biological characteristics in elderly Korean women than in Korean women of all ages or elderly women globally.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
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4
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Morgan JL, George J, Holmes G, Martin C, Reed MWR, Ward S, Walters SJ, Cheung KL, Audisio RA, Wyld L. Breast cancer surgery in older women: outcomes of the Bridging Age Gap in Breast Cancer study. Br J Surg 2020; 107:1468-1479. [DOI: 10.1002/bjs.11617] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/23/2019] [Accepted: 03/15/2020] [Indexed: 01/04/2023]
Abstract
Abstract
Background
Breast cancer surgery in older women is variable and sometimes non-standard owing to concerns about morbidity. Bridging the Age Gap in Breast Cancer is a prospective multicentre cohort study aiming to determine factors influencing treatment selection and outcomes from surgery for older patients with breast cancer.
Methods
Women aged at least 70 years with operable breast cancer were recruited from 57 UK breast units between 2013 and 2018. Associations between patient and tumour characteristics and type of surgery in the breast and axilla were evaluated using univariable and multivariable analyses. Oncological outcomes, adverse events and quality-of-life (QoL) outcomes were monitored for 2 years.
Results
Among 3375 women recruited, surgery was performed in 2816 patients, of whom 24 with inadequate data were excluded. Sixty-two women had bilateral tumours, giving a total of 2854 surgical events. Median age was 76 (range 70–95) years. Breast surgery comprised mastectomy in 1138 and breast-conserving surgery in 1716 procedures. Axillary surgery comprised axillary lymph node dissection in 575 and sentinel node biopsy in 2203; 76 had no axillary surgery. Age, frailty, dementia and co-morbidities were predictors of mastectomy (multivariable odds ratio (OR) for age 1·06, 95 per cent c.i. 1·05 to 1·08). Age, frailty and co-morbidity were significant predictors of no axillary surgery (OR for age 0·91, 0·87 to 0·96). The rate of adverse events was moderate (551 of 2854, 19·3 per cent), with no 30-day mortality. Long-term QoL and functional independence were adversely affected by surgery.
Conclusion
Breast cancer surgery is safe in women aged 70 years or more, with serious adverse events being rare and no mortality. Age, ill health and frailty all influence surgical decision-making. Surgery has a negative impact on QoL and independence, which must be considered when counselling patients about choices.
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Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - J George
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - S Ward
- Department of Health Economics and Decision Science, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K Leung Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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5
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Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients? Ir J Med Sci 2018; 188:379-388. [DOI: 10.1007/s11845-018-1851-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022]
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6
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Current Strategies of Endocrine Therapy in Elderly Patients with Breast Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6074808. [PMID: 29581979 PMCID: PMC5822785 DOI: 10.1155/2018/6074808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Abstract
Currently, the growing population of the elderly is one of biggest problems in terms of increase in geriatric diseases. Lack of data from large prospective studies on geriatric breast cancer patients often makes it difficult for clinicians to make treatments decisions for them. Because both benefit and risk of treatment should be taken into account, treatment is usually determined considering life expectancy or comorbidities in elderly patients. Treatment of breast cancer is differentiated according to histologic classifications, and hormone therapy is even adopted for patients with metastatic breast cancer if tumor tissue expresses hormone receptors. Endocrine therapy can offer great benefit to elderly patients considering its equivalent efficacy to chemotherapy with fewer toxicities if it is appropriately used. Aromatase inhibitors are usually prescribed agents in hormone therapy for elderly breast cancer patients due to their physiology after menopause. Here, endocrine therapy for elderly patients with breast cancer in neoadjuvant, adjuvant, and palliative setting is reviewed along with predictive adverse events resulting from the use of hormone agents.
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7
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Lodi M, Scheer L, Reix N, Heitz D, Carin AJ, Thiébaut N, Neuberger K, Tomasetto C, Mathelin C. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 2017; 166:657-668. [PMID: 28803352 DOI: 10.1007/s10549-017-4448-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. METHODS We reviewed 63 original articles published between 2006 and 2016 concerning women over 70 years with breast cancer. RESULTS Compared to patients 70-79 years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p < 0.01) and more T2 lesions (43.5% vs 33.0%, p < 0.01). Lymph nodes and distant metastases were more frequent, with more N + (49.5% vs 44.0%, p < 0.01) and more M1 (8.0% vs 5.9%, p < 0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p < 0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p = 0.01) and fewer grade 3 (21.5% vs 25.5%, p < 0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p < 0.01). Lympho-vascular invasion was less frequent in the 80 years and over (22.9% vs 29.7%, p = 0.01). Breast cancer-specific mortality was higher both at 5 years (25.8% vs 17.2%, p < 0.01) and 10 years (32.7% vs 26.6%, p < 0.01). CONCLUSION Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.
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Affiliation(s)
- M Lodi
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.
| | - L Scheer
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France
| | - N Reix
- ICube, UMR 7357, Strasbourg University/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 300 Boulevard Sébastien Brant, 67400, Illkirch-Graffenstaden, France.,Biochemistry and Molecular Biology Laboratory, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - D Heitz
- Onco-geriatric Unit, Strasbourg University Hospital, 1 Avenue Molière, 67200, Strasbourg, France
| | - A-J Carin
- Gynecology Department, Haguenau General Hospital, 64 Avenue du Professeur Leriche, 67504, Haguenau, France
| | - N Thiébaut
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - K Neuberger
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - C Tomasetto
- Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France
| | - C Mathelin
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.,Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France.,Hôpital Saint Nicolas, Sarrebourg General Hospital, 25 Avenue du Général de Gaulle, 57400, Sarrebourg, France
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Chakraborty A, Bose CK, Basak J, Sen AN, Mishra R, Mukhopadhyay A. Determinants of lymph node status in women with breast cancer: A hospital based study from eastern India. Indian J Med Res 2017; 143:S45-S51. [PMID: 27748277 PMCID: PMC5080928 DOI: 10.4103/0971-5916.191761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background & objectives: Number of metastatic lymph nodes has a strong prognostic value in the course of breast cancer treatment, morbidity and mortality. This study was undertaken to determine the association between axillary lymph node metastasis and several variables such as age, tumour size, grade, lymphovascular invasion, oestrogen and progesterone receptor expression and HER2/neu status in patients with breast cancer. Methods: In this study 426 (with complete information on study variables) patients with breast cancer on treatment during March 2010 to December 2013, were analyzed. TNM (tumour node matastasis) staging was evaluated. The histological grading of tumours was done according to modified Bloom-Richardson Grading System. The immunophenotype of the tumour was determined as the expression of oestrogen (ER) and progesterone (PR) receptors and HER2/neu status. Univariate and multivariate analyses were carried out to determine the independent predictors of metastatic lymph node. Results: Among the studied patients, 44.36 per cent (189 of 426) of the patients had nodal metastases. Tumour histology, tumour grade, size and lympho-vascular invasion were related with node positivity. On univariate analysis, age, menopause, hormone receptor status did not relate with the node metastasis. Age, tumour grade, tumour size, lympho-vascular invasion and HER2/neu expression was likely to be associated with the number of lymph node metastasis. Interpretation & conclusions: The lymph node status was associated with clinical stage, tumour grade, tumour histology and HER2/neu status. These factors may be used for better management of such patients.
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Affiliation(s)
- Abhijit Chakraborty
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Chinmoy Kumar Bose
- Department of Gynecological Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Jayasri Basak
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Aditya Narayan Sen
- Department of Surgical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
| | - Raghwendra Mishra
- Department of Physiology, Ananda Mohan College, University of Calcutta, Kolkata, India
| | - Ashis Mukhopadhyay
- Department of Medical Oncology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, India
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9
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Dellapasqua S. Systemic Treatment for Specific Medical Situations. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Leone J, Leone BA, Leone JP. Adjuvant systemic therapy in older women with breast cancer. BREAST CANCER-TARGETS AND THERAPY 2016; 8:141-7. [PMID: 27524919 PMCID: PMC4966695 DOI: 10.2147/bctt.s110765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Breast cancer in the elderly is an increasing clinical problem. In addition, ~60% of deaths from breast cancer occur in women aged 65 years and older. Despite this, older women with breast cancer have been underrepresented in clinical trials, and this has led to less than optimal evidence to guide their therapy. The management of elderly women with early breast cancer is a complex process that requires careful evaluation of life expectancy, comorbidities, patient values, and risks and benefits of available treatment options. This review will focus on current adjuvant systemic therapy options for older women with breast cancer, discuss the principles in the decision-making process, and define the role of endocrine therapy, chemotherapy, and targeted agents.
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Affiliation(s)
- Julieta Leone
- Department of Medical Oncology, Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina
| | - Bernardo Amadeo Leone
- Department of Medical Oncology, Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina
| | - José Pablo Leone
- Department of Internal Medicine, Division of Hematology-Oncology and Blood & Marrow Transplantation, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA
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Engels CC, Kiderlen M, Bastiaannet E, van Eijk R, Mooyaart A, Smit VTHBM, de Craen AJM, Kuppen PJK, Kroep JR, van de Velde CJH, Liefers GJ. The clinical value of HER-2 overexpression and PIK3CA mutations in the older breast cancer population: a FOCUS study analysis. Breast Cancer Res Treat 2016; 156:361-70. [PMID: 26968397 PMCID: PMC4819549 DOI: 10.1007/s10549-016-3734-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/23/2016] [Indexed: 01/17/2023]
Abstract
Studies to confirm the effect of acknowledged prognostic markers in older breast cancer patients are scarce. The aim of this study was to evaluate the prognostic value of HER-2 overexpression and PIK3CA mutations in older breast cancer patients. Female breast cancer patients aged 65 years or older, diagnosed between 1997 and 2004 in a geographical region in The Netherlands, with an invasive, non-metastatic tumour and tumour material available, were included in the study. The primary endpoint was relapse-free period and secondary endpoint was relative survival. Determinants were immunochemical HER-2 scores (0/1+, 2+ or 3+) and PIK3CA as a binary measure. Overall, 1698 patients were included, and 103 had a HER-2 score of 3+. HER-2 overexpression was associated with a higher recurrence risk (5 years recurrence risk 34 % vs. 12 %, adjusted p = 0.005), and a worse relative survival (10 years relative survival 48 % vs. 84 % for HER-2 negative; p = 0.004). PIK3CA mutations had no significant prognostic effect. We showed, in older breast cancer patients, that HER-2 overexpression was significantly associated with a worse outcome, but PIK3CA mutations had no prognostic effect. These results imply that older patients with HER-2 overexpressing breast cancer might benefit from additional targeted anti-HER-2 therapy.
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Affiliation(s)
- Charla C Engels
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Mandy Kiderlen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. .,Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.,Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronald van Eijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antien Mooyaart
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J M de Craen
- Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Dimitrakopoulos FID, Kottorou A, Antonacopoulou AG, Makatsoris T, Kalofonos HP. Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem. J Breast Cancer 2015; 18:207-17. [PMID: 26472970 PMCID: PMC4600684 DOI: 10.4048/jbc.2015.18.3.207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/20/2015] [Indexed: 01/06/2023] Open
Abstract
Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.
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Affiliation(s)
| | - Anastasia Kottorou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Anna G Antonacopoulou
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Thomas Makatsoris
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
| | - Haralabos P Kalofonos
- Division of Oncology, Department of Medicine, University of Patras Medical School, Patras, Greece
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Oran ES, Yankol Y, Soybir GR, Karsidag T, Sakalli O, Gecgel U, Soybir OC, Soran A. Distinct postsurgical management in young and elderly breast cancer patients results in equal survival rates. Asian Pac J Cancer Prev 2015; 15:7843-7. [PMID: 25292075 DOI: 10.7314/apjcp.2014.15.18.7843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although breast cancer (BC) is one of the most common malignant diseases in women, the majority of the studies describing the characteristics of BC in elderly patients have been limited to survival assessments or tumor features, without using younger BC patients as a reference group. The aim of our study was to describe and compare tumor characteristics and management patterns in elderly versus younger breast cancer patients in Turkey. MATERIALS AND METHODS We retrospectively analyzed 152 patients with invasive breast cancer who underwent surgery in our institution between 2002 and 2012. Patients were divided into 2 groups according to age at the time of diagnosis. RESULTS There were 62 patients in the elderly group (≥65 years) and 90 patients in the younger group (<65 years). Compared to the younger group, tumors in the elderly group were more likely to be larger (p=0.018), of lower grade (p=0.005), and hormone receptor-positive (p>0.001). There were no significant differences regarding histology, localization, lymph node involvement, or types of surgical procedures between the 2 groups. Comorbidities were more common in elderly patients (p<0.001). In addition, elderly patients were more likely to receive hormonal therapy (p<0.001) and less likely to receive radiotherapy (p=0.08) and chemotherapy (p=0.003). There was no difference in survival and locoregional recurrence rates between the groups. CONCLUSIONS The results of this study demonstrate that breast cancer in elderly patients has more favorable tumor features, warranting less aggressive treatment regimens after surgery.
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Affiliation(s)
- Ebru Sen Oran
- Department of General Surgery, Medical Faculty, Namik Kemal University, Tekirdag, Turkey E-mail :
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Pathologic and clinical characteristics of elderly patients with breast cancer: a retrospective analysis of a multicenter study (Anatolian Society of Medical Oncology). Int Surg 2015; 99:2-7. [PMID: 24444261 DOI: 10.9738/intsurg-d-13-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.
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Tang LC, Jin X, Yang HY, He M, Chang H, Shao ZM, Di GH. Luminal B subtype: a key factor for the worse prognosis of young breast cancer patients in China. BMC Cancer 2015; 15:201. [PMID: 25885213 PMCID: PMC4389816 DOI: 10.1186/s12885-015-1207-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/17/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prognoses of young breast cancer patients are poor. The purpose of this study is to evaluate the different characteristics and prognoses among different subtypes of young breast cancer patients. METHODS The study included 1360 patients <40 years-old (y) and 3110 patients 40-50y with operable breast cancer in Shanghai Cancer Center, Fudan University. The characteristics, overall survival (OS) and disease-free survival (DFS) were compared. RESULTS The median follow-up was 54.1 months. More grade III tumors and more lymph-vascular invasions (P < 0.01) were presented in <40y group when compared with 40-50y group. More patients <40y presented with Luminal B (25.3% vs. 17.5%, P < 0.01) and triple negative (16.7% vs. 13.4%, P < 0.05) breast cancer while fewer had Luminal A tumor (48.5% vs. 59.2%, P < 0.01). Younger patients with tumors of both Luminal A and Luminal B types were at increased risk for worse DFS (P = 0.03, HR = 1.69, 95% CI = 1.05-2.72; P < 0.01, HR = 3.61, 95% CI = 2.50-5.22) when compared with the older patients. Patients <40y with Luminal B tumor had a two point five fold higher risk of death compared with older counterparts (P < 0.01, HR = 2.54, 95% CI = 1.35-4.79), however, a worse overall survival rate was not observed in the younger women with Luminal A breast cancer (P > 0.05). In multivariate analysis, Luminal B subtype was also a strong predictor of disease relapse (HR = 1.09, 95% CI = 1.01 to 1.19, P < 0.01) in younger patients with Luminal subtype tumors. CONCLUSION Characteristics of breast cancer suggested a more aggressive biology in Chinese patients with breast cancer diagnosed at young age. Luminal B subtype may have a negative effect on the prognosis of young patients in China which should be validated further.
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Affiliation(s)
- Li-Chen Tang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Xi Jin
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Hai-Yuan Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Min He
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Helena Chang
- Department of Surgery, Revlon/UCLA Breast Canter, David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Zhi-Ming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Gen-Hong Di
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Afsharfard A, Mozaffar M, Orang E, Tahmasbpour E. Trends in epidemiology, clinical and histopathological characteristics of breast cancer in Iran: results of a 17 year study. Asian Pac J Cancer Prev 2014; 14:6905-11. [PMID: 24377624 DOI: 10.7314/apjcp.2013.14.11.6905] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is the top cancer among women worldwide and the most frequent malignancy among Iranian women over the past few decades. The increasing trend and high mortality rate of BC in the developing world necessitates studies concentrating on its characteristics in countries in Asia. The current study focused on clinical and histopathological features of BC among Iranian females. MATERIALS AND METHODS This retrospective study involved 714 Iranian patients with histopathologically proven BC undergoing resection of primary tumours and axillary clearance. Demographic, clinical and histopathological data were obtained and studied between ten year age groups (≤ 40 years, 41-50 years, 51-60 years, 61-70 years, and ≤ 71 years) in four chronologic phases from 1994-2009. RESULTS Mean age of patients was 49.4 ± 13.1 years. Most of cases (33.2%) were in 41-50 group. Mean size of primary tumors was 3.94 ± 2.47 cm and 87.1% of cases had infiltrative ductal carcinoma. Modified radical mastectomy was the most common method of surgery carried out (48.8%). Some 57.1% of tumors were in pT2 and tumor size decreased significantly during the period (p<0.05). The most common BC stage was llla (27%). Lower BC stages (0 and 1) constituted 13.9% of the diagnosed tumors. Our series of patients aged ≤ 40 had larger tumors (mean 4.73 ≤ 3.02 cm) compared to older age groups (p=0.003). Lower stages (0 and I) were more frequent among the oldest patients while nearly 50% of patients aged ≤ 40 had tumor stage III. We also observed a significant decreasing trend in the mean LN count (p<0.05) and blood vessel invasion (p=0.023) from younger to older age groups. CONCLUSIONS More aggressive disease for younger age groups, earlier peak incidence age and high rate of advanced BC at the time of diagnosis among Iranian women, were the main findings of this study.
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Affiliation(s)
- Aboulfazl Afsharfard
- Department of Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail :
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Bates T, Evans T, Lagord C, Monypenny I, Kearins O, Lawrence G. A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women. Eur J Surg Oncol 2014; 40:1230-6. [PMID: 25081093 DOI: 10.1016/j.ejso.2014.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. METHODS 37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size. RESULTS The proportion of women not having surgery increased from 7-10% at ages 35-69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70-79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0-39, the deprived and certain ethnic groups (p < 0.02). CONCLUSIONS From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group.
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Affiliation(s)
- T Bates
- The Breast Unit, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK.
| | - T Evans
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
| | - C Lagord
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
| | - I Monypenny
- Llandough University Hospital, Cardiff CF 64 2XX, UK
| | - O Kearins
- Public Health England, Cancer Screening QA Reference Centre, Birmingham B3 2PW, UK
| | - G Lawrence
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
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Shelby RA, Edmond SN, Wren AA, Keefe FJ, Peppercorn JM, Marcom PK, Blackwell KL, Kimmick GG. Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy. Support Care Cancer 2014; 22:2851-9. [PMID: 24821365 DOI: 10.1007/s00520-014-2269-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer. METHODS One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years). RESULTS Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p < 0.05). Self-efficacy for coping with symptoms moderated the relationship between physical symptoms and functional (B = 0.05, SE = 0.02, t = 2.67, p = 0.009) and emotional well-being (B = 0.03, SE = 0.01, t = 2.45, p = 0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being. CONCLUSIONS Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.
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Affiliation(s)
- Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, 27705, NC, USA,
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Özmen V. Breast Cancer in Turkey: Clinical and Histopathological Characteristics (Analysis of 13.240 Patients). THE JOURNAL OF BREAST HEALTH 2014; 10:98-105. [PMID: 28331652 DOI: 10.5152/tjbh.2014.1988] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/06/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Breast cancer is the most common type of cancer and the leading cause of cancer related deaths in women in Turkey, as elsewhere around the world. However, detailed and systematic demographics, data on clinical and pathological characteristics, and treatment were largely unavailable in Turkey until now. This paper is intended to provide an analysis of clinical and pathological data on women registered in the National Breast Cancer Database (Ulusal Meme Kanseri Veri Tabanı [UMKVT]), established within Turkish Federation of Breast Diseases Societies (TMHDF) and available for use in Turkey since 2005. MATERIALS AND METHODS Clinical and pathological data on breast cancer patients registered online in the database from May 01, 2005 to May 01, 2011 were investigated. Parameters examined in patients included age, menopausal status, distribution of clinical and pathological stage, histological type, tumor diameter, histological grades, regional lymphatic stage, estrogen (ER), progesterone (PR), HER-2 receptors and molecular subtypes. Analysis results of these parameters were compared with literature data and discussed. RESULTS A total of 13,240 patients with breast cancer since April 07, 1992 were included in the study, and 99% of them were female. Female breast cancer patients whose requisite parameters had been completely entered in the database were included in the analysis. The mean age was 51.6 years (±12.6; range 12-97), 17% of them were younger than 40 years of age, and 45% were premenopausal. According to an analysis of age groups at diagnosis, the frequency of cancer peaked at the 45 - 49 age group with 16.7%, declining to 7.6% in the 65-69 age group, and then rose again. Most of the patients (78.7%) had invasive ductal, 7.8% were invasive lobular cancers, 9.8% were invasive mixed cancers (invasive ductal + invasive lobular), and 4% were other histological types (e.g. inflammatory, intracystic papillary, mucinous, etc.), respectively. Half of them (50%) had grade III histology. According to an analysis of pathological stages of all breast cancers (stage 0 - IV), 5% were stage 0, 27% were stage I, 44% were stage II, 21% were stage III, and 3% were stage IV breast cancer, respectively. The mean tumor diameter was 2.5 cm (±1.6; range 0.1-20 cm). The rates of lymphatic stages were pN0 50%, pN1 28%, pN2 15%, and pN3 7%, respectively. ER, PR, and HER-2 receptors were positive in 70%, 59%, and 23% of patients. A subtype analysis of tumors showed that 62% were type luminal A. This was followed by subtypes luminal B (15%), triple negative (15%), and HER-2 positive (8.5%). CONCLUSION As a conclusion patients with breast cancer in our breast cancer registry program were younger, and had more advanced disease, and worse prognostic factors than patients in developed countries.
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Affiliation(s)
- Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey
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Albanell J, Ciruelos EM, Lluch A, Muñoz M, Rodríguez CA. Trastuzumab in small tumours and in elderly women. Cancer Treat Rev 2014; 40:41-7. [DOI: 10.1016/j.ctrv.2013.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/30/2022]
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Greer LT, Rosman M, Charles Mylander W, Liang W, Buras RR, Chagpar AB, Edwards MJ, Tafra L. A prediction model for the presence of axillary lymph node involvement in women with invasive breast cancer: a focus on older women. Breast J 2014; 20:147-53. [PMID: 24475876 DOI: 10.1111/tbj.12233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Axillary lymph node (ALN) status at diagnosis is the most powerful prognostic indicator for patients with breast cancer. Our aim is to examine the contribution of variables that lead to ALN metastases in a large dataset with a high proportion of patients greater than 70 years old. Using the data from two multicenter prospective studies, a retrospective review was performed on 2,812 patients diagnosed with clinically node-negative invasive breast cancer from 1996 to 2005 and who underwent ALN sampling. Univariate and multivariate logistic regression were used to identify variables that were strongly associated with axillary metastases, and an equation was developed to estimate risk of ALN metastases. Of the 2,812 patients with invasive breast cancer, 18% had ALN metastases at diagnosis. Based on univariate analysis, tumor size, lymphovascular invasion (LVI), tumor grade, age at diagnosis, menopausal status, race, tumor location, tumor type, and estrogen and progesterone receptor status were statistically significant. The relationship between age and involvement of axillary metastases was nonlinear. In multivariate analysis, LVI, tumor size and menopausal status were the most significant factors associated with ALN metastases. Age, however, was not a significant contributing factor for axillary metastases. Tumor size, LVI, and menopausal status are strongly associated with ALN metastases. We believe that age may have been a strong factor in previous analyses because there was not an adequate representation of women in older age groups and because of the violation of the assumption of linearity in their multivariate analyses.
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Affiliation(s)
- Lauren T Greer
- General Surgery Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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Tran P, Fentiman IS. Better treatment for breast cancer in older patients. Expert Rev Anticancer Ther 2014; 9:1081-90. [DOI: 10.1586/era.09.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Laird-Fick HS, Gardiner JC, Tokala H, Patel P, Wei S, Dimitrov NV. HER2 status in elderly women with breast cancer. J Geriatr Oncol 2013; 4:362-7. [DOI: 10.1016/j.jgo.2013.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/11/2013] [Accepted: 05/31/2013] [Indexed: 11/16/2022]
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Abstract
This article describes the range of cancer patients in longterm care and provides a framework for clinical decision making. The benefits and burdens of providing standard therapy to a vulnerable population are discussed. To give more specific guidelines for advocates of treatment, skeptics, and others, the authors present best estimates of the current burden of cancer in the long-term care population and current screening guidelines that apply to the elderly under long-term care. Experience-based suggestions are offered for oncologists and clinicians involved in long-term care to help them respond to patient and family concerns about limitations of cancer care.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Pivot X, Schneeweiss A, Verma S, Thomssen C, Passos-Coelho JL, Benedetti G, Ciruelos E, von Moos R, Chang HT, Duenne AA, Miles DW. Efficacy and safety of bevacizumab in combination with docetaxel for the first-line treatment of elderly patients with locally recurrent or metastatic breast cancer: results from AVADO. Eur J Cancer 2011; 47:2387-95. [PMID: 21757334 DOI: 10.1016/j.ejca.2011.06.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 06/07/2011] [Accepted: 06/07/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Oncologic treatment in elderly patients is challenging, due to comorbidities, often impaired organ function, limited clinical trial evidence, inadequate guidelines and no consistent 'elderly' definition. We report exploratory sub-analyses of safety and efficacy in elderly patients, defined as ⩾ 65years old, in AVastin And DOcetaxel (AVADO) receiving first-line bevacizumab plus docetaxel for metastatic breast cancer (mBC). PATIENTS AND METHODS Patients with HER2-negative, locally recurrent or mBC were randomised to 3-weekly docetaxel (100mg/m(2)) with placebo, bevacizumab 7.5mg/kg or bevacizumab 15 mg/kg, for 9 cycles or until disease progression or unacceptable toxicity. Patients had no prior chemotherapy for mBC. RESULTS Progression-free survival (PFS) was increased with bevacizumab in the elderly subpopulation (n=127), the effect being greater with higher dose (hazard ratio=0.63 [95% confidence interval (CI) 0.383-1.032] versus 0.76 [95% CI: 0.46-1.262], respectively). PFS was numerically similar in the elderly and overall populations, but the former failed to achieve statistical significance. Overall response rates for docetaxel plus placebo, bevacizumab 7.5mg/kg and 15 mg/kg were 44.7%, 36.6% and 50.0%, respectively. Effects on survival were not statistically significant. Bevacizumab was well tolerated in elderly patients, the most common adverse effects were neutropenia and febrile neutropenia; there was no excess of grade⩾3 cardiovascular events. There was no clear correlation between baseline hypertension and its development during study treatment. CONCLUSIONS In this exploratory sub-analysis in AVADO, bevacizumab plus docetaxel showed efficacy in elderly patients similar to the overall study population. There were no unexpected safety signals in patients aged 65 years or older.
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Spano JP, Falandry C, Chaibi P, Freyer G. Current targeted therapies in breast cancer: clinical applications in the elderly woman. Oncologist 2011; 16:1144-53. [PMID: 21705664 DOI: 10.1634/theoncologist.2011-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The incidence of breast cancer is two to three times higher in women aged ≥65 years than in the whole population, whereas their mortality rate is threefold to fourfold higher. Targeted therapies allow significantly longer disease-free survival times. Nevertheless, in an elderly population, these treatments need to be prescribed with caution. This paper reviews the treatments of breast cancer in the elderly, and the issues of targeted therapies and their toxicities. Patients with human epidermal growth factor receptor (HER)-2(+) breast cancer benefit from trastuzumab; although cardiotoxic effects are observed in <5% of patients when given alone, they affect ~25% of patients when combined with anthracyclines. Bevacizumab leads to a longer progression-free survival time and lower risk for progression in patients with metastatic breast cancer when added to paclitaxel or docetaxel. Although generally well tolerated, it is associated with a higher risk for arterial thromboembolism and hypertension. Lapatinib is approved for the treatment of advanced or metastatic breast cancer in patients not responding to trastuzumab, combined with capecitabine chemotherapy. The most frequent side effects concern the gastrointestinal system and dermatologic symptoms. The life expectancy of breast cancer patients should be taken into account to determine the appropriateness of treatments. The quality of life of elderly cancer patients must be assessed with an appropriate tool. Older patients exhibit greater vulnerability, suggesting identification and exclusion of patients at high cardiac risk. Future recommendations for the treatment of elderly women with breast cancer should include a multidisciplinary approach and a global geriatric assessment before treatment with anti-HER-2 therapy or bevacizumab.
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Affiliation(s)
- Jean-Philippe Spano
- Groupe Hospitalier de la Pitié-Salpétrière, Département d’Oncologie Médicale du Prof. David Khayat, Paris, France.
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Place des thérapies ciblées chez la patiente âgée atteinte de cancer du sein. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Saxena N, Hartman M, Hussain Z, Pathy NB, Iau P, Lee SC, Lee KM, Lim SE, Wong JE, Verkooijen HM. Impact of older age on presentation, management and outcome of breast cancer in the multi-ethnic Asian population of Singapore. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chatzidaki P, Mellos C, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol 2010; 18:923-31. [PMID: 21107743 DOI: 10.1245/s10434-010-1389-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE There has been much controversy regarding the optimal management of breast cancer in very elderly women. Some clinicians are reluctant to offer surgical treatment for women older than aged 80 years because of the assumed higher operative risk associated with advanced age. This study was designed to investigate the perioperative complications of breast cancer surgery in women of this age group. METHODS Data were reviewed of all women ≥80 years of age who underwent breast cancer surgery at a university clinic during the period 1990-2005. Symptoms, comorbidities, preoperative risk assessment, type of operation, postoperative histological diagnosis, hospital stay, morbidity, and mortality were documented and analyzed. RESULTS During this 16-year period, 140 operations for breast cancer were performed in 129 women. The majority of the patients (37.9%) underwent a modified radical mastectomy, 32.1% underwent a simple mastectomy, 24.3% underwent breast-conserving therapy, and 5.7% underwent an axillary lymph node dissection. Complications occurred in 37.1% of the cohort: 31.4% were minor complications and only 5.7% were major. Intraoperative morbidity was 18.6% and postoperative morbidity was 20%. Late complications occurred in 5% of patients. The most common complications were associated with the wound region (50%). The perioperative mortality in this group of elderly women was zero. CONCLUSIONS Breast cancer surgery has acceptable perioperative morbidity and mortality in women aged ≥80 years. Surgery is the cornerstone of breast cancer treatment and should be offered as first-line treatment for all patients regardless of their age.
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Affiliation(s)
- Paraskevi Chatzidaki
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Chatzidaki P, Mellos C, Briese V, Mylonas I. Does primary breast cancer in older women (≥80 years) have unfavorable histological characteristics? Arch Gynecol Obstet 2010; 284:705-12. [PMID: 20949358 DOI: 10.1007/s00404-010-1697-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although the majority of breast cancer patients are older than 65 years, limited data exist regarding the pathological features in very elderly patients. The aim of this study was to evaluate the histological characteristics of breast cancer in women aged over 80 years. METHODS The histological data were reviewed for 137 women aged 80 years and older who were diagnosed with primary breast carcinoma at a university clinic during the period 1990-2005. RESULTS Although it is believed that older women have more advanced tumor, the majority of the tumors were assessed as stage I (35%) and II (32.9%). Mucinous, papillary, medullary, tubular, and cribriform histological subtypes have been demonstrated often in this age group (16.8%). In 49.7 and 70.6% of cases, respectively, there were no regional lymph node metastases and no distant metastases. The frequency of ER-positive (72%) and PR-positive (56%) tumors in these patients is high. CONCLUSIONS An accurate prognostic evaluation at the time of initial diagnosis is of high importance for older patients, since this could avoid unnecessary and risky therapies. As an increasing number of women ≥80 years old may be diagnosed with breast cancer in the coming years, treatment in this specific age group should be individualized to the patient and tumor factors.
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Affiliation(s)
- Paraskevi Chatzidaki
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Vinh-Hung V, Joseph SA, Coutty N, Ly BH, Vlastos G, Nguyen NP. Age and axillary lymph node ratio in postmenopausal women with T1-T2 node positive breast cancer. Oncologist 2010; 15:1050-62. [PMID: 20930094 DOI: 10.1634/theoncologist.2010-0044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The purpose of this article was to examine the relationship between age and lymph node ratio (LNR, number of positive nodes divided by number of examined nodes), and to determine their effects on breast cancer (BC) and overall mortality. METHODS Women aged ≥50 years, diagnosed in 1988-1997 with a unilateral histologically confirmed T1-T2 node positive surgically treated primary nonmetastatic BC, were selected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER). Generalized Additive Models for Location Scale and Shape (GAMLSS) were used to evaluate the age-LNR relationship. Cumulative incidence functions and multivariate competing risks analysis based on model selection by the Bayesian Information Criterion (BIC) were used to examine the effect of age and LNR on mortality. Low LNR was defined as ≤0.20, mid-LNR 0.21-0.65, and high LNR >0.65. RESULTS GAMLSS showed a nonlinear LNR-age relationship, increasing from mean LNR 0.26-0.28 at age 50-70 years to 0.30 at 80 years and 0.40 at 90 years. Compared with a 9.8% [95% confidence interval (CI) 8.8%-10.8%] risk of BC death at 5 years in women aged 50-59 years with low LNR, the risk in women ≥80 years with low LNR was 12.6% [95% CI 10.1%-15.0%], mid-LNR 18.1% [13.9%-22.1%], high LNR 29.8% [22.7%-36.1%]. Five-years overall risk of death increased from 40.8% [37.5%-43.9%] by low LNR to 67.4% [61.4%-72.4%] by high LNR. The overall mortality hazard ratio for age ≥80 years with high LNR was 7.49 [6.54-8.59], as compared with women aged 50-59 years with low LNR. CONCLUSION High LNR combined with older age was associated with a threefold increased risk of BC death and a sevenfold increased hazard ratio of overall mortality.
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Bajén MT, Benítez AM, Domènech A, Ricart Y, Mora J, Notta P, Ramal D, Urruticoechea A, Soler T, Martín-Comin J. [Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women]. ACTA ACUST UNITED AC 2010; 29:289-92. [PMID: 20828880 DOI: 10.1016/j.remn.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed. METHODS A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥ 70 years old; B, younger postmenopausal, 89 patients, 55-69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months. STATISTICAL ANALYSIS chi-squared test, significance: P ≤ 0.05. RESULTS SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours. CONCLUSION SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.
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Affiliation(s)
- M T Bajén
- Servicio de Medicina Nuclear, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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Botteri E, Bagnardi V, Goldhirsch A, Viale G, Rotmensz N. Axillary Lymph Node Involvement in Women With Breast Cancer: Does It Depend on Age? Clin Breast Cancer 2010; 10:318-21. [DOI: 10.3816/cbc.2010.n.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A straightforward but not piecewise relationship between age and lymph node status in Chinese breast cancer patients. PLoS One 2010; 5:e11035. [PMID: 20543953 PMCID: PMC2882951 DOI: 10.1371/journal.pone.0011035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 05/17/2010] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the relationship between age and axillary lymph node (LN) involvement in Chinese breast cancer patients, and to replicate a recently identified piecewise relationship between age and LN involvement. Methods A dataset, consisting of 3,715 patients (with complete information on study variables) with operable breast cancer consecutively surgically treated between 1996 and 2006, was derived from the database of Shanghai Cancer Hospital. Univariate and multivariate logistic regression were employed to analyze the relationship between age and LN. We subsequently performed a similar analysis on another dataset including 1,832 consecutive patients treated between 2007 and 2008 to replicate our findings in the first dataset. Results A U-shaped relationship (previously observed in two European populations) between age and LN status failed to be replicated in our dataset of Chinese patients. Instead, we observed a linear rather than piecewise relationship. After multivariate adjustment, the linear relationship was still present. Moreover, the interaction between age and LN involvement was not modified by tumor size. The odds of LN involvement decreased by 1.5% for each year increase in age (OR 0.985, 95% CI 0.979–0.991, P<0.001). Breast cancer subtypes were also associated with LN status. Proportions of basal-like and ERBB2+ subtypes decreased with increasing age. The observations in the first dataset were successfully replicated in a second independent dataset. Conclusion We confirmed a straightforward but not piecewise relationship between age and LN status in Chinese patients. The different pattern between Chinese and European elderly patients should be considered when making clinical decisions.
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Crivellari D, Spazzapan S, Puglisi F, Fratino L, Scalone S, Veronesi A. Hormone therapy in elderly breast cancer patients with comorbidities. Crit Rev Oncol Hematol 2010; 73:92-8. [DOI: 10.1016/j.critrevonc.2009.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/21/2009] [Accepted: 02/19/2009] [Indexed: 10/20/2022] Open
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Tse GM, Tan PH, Lau KM, de Andrade VP, Lui PCW, Vong JS, Chaiwun B, Lam CC, Yu AM, Moriya T. Breast cancer in the elderly: a histological assessment. Histopathology 2009; 55:441-51. [DOI: 10.1111/j.1365-2559.2009.03400.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cutuli B, De Lafontan B, Vitali E, Costa L, Aristei C, Marchal C, Quetin P, Fay R. Breast conserving treatment (BCT) for stage I–II breast cancer in elderly women: Analysis of 927 cases. Crit Rev Oncol Hematol 2009; 71:79-88. [DOI: 10.1016/j.critrevonc.2008.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 09/16/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022] Open
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Wildiers H, Van Calster B, van de Poll-Franse LV, Hendrickx W, Røislien J, Smeets A, Paridaens R, Deraedt K, Leunen K, Weltens C, Van Huffel S, Christiaens MR, Neven P. Relationship Between Age and Axillary Lymph Node Involvement in Women With Breast Cancer. J Clin Oncol 2009; 27:2931-7. [DOI: 10.1200/jco.2008.16.7619] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To study the relation between the presence of axillary lymph node (LN) involvement and age in breast cancer. Patients and Methods The breast cancer database of the University Hospitals Leuven contains complete data on 2,227 patients with early breast cancer consecutively treated between 2000 and 2005. A multivariate piecewise logistic regression model was used to analyze LN involvement in relation to age at diagnosis. A similar analysis was then performed on a large, independent, population-based database from the Eindhoven Cancer Registry to investigate whether the effects of the Leuven model could be replicated. Results We observed a piecewise effect of age. That is, women up to 70 years of age were less likely to have positive LNs with increasing age (odds ratio per 10-year increase, 0.87). In contrast, older women were more likely to have positive LNs with increasing age. However, for older women, the effect of age interacted with tumor size (P = .0044), suggesting that increasing age is associated with increased risk of LN involvement, mainly in small tumors. These findings were replicated in the Eindhoven Cancer Registry database. Conclusion Axillary LN involvement varies with age at diagnosis; its probability decreases with increasing age up to the age of approximately 70 years, but increases again thereafter. However, this increase is mainly seen in smaller tumors and suggests a different behavior of small breast cancers in older adult patients. We hypothesize that decreased immune defense mechanisms, related with aging, may play a role in earlier invasion into LNs.
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Affiliation(s)
- Hans Wildiers
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Ben Van Calster
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Lonneke V. van de Poll-Franse
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Wouter Hendrickx
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Jo Røislien
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Ann Smeets
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Robert Paridaens
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Karen Deraedt
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Karin Leunen
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Caroline Weltens
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Sabine Van Huffel
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Marie-Rose Christiaens
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Patrick Neven
- From the Multidisciplinary Breast Centre and Departments of General Medical Oncology, Pathology, Gynecology, and Radiotherapy, University Hospitals Leuven; Department of Electrical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, the Netherlands; and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
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Ma CD, Zhou Q, Nie XQ, Liu GY, Di GH, Wu J, Lu JS, Yang WT, Chen JY, Shao ZM, Shen KW, Shen ZZ. Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns. Crit Rev Oncol Hematol 2009; 71:258-65. [PMID: 19150602 DOI: 10.1016/j.critrevonc.2008.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 11/20/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022] Open
Abstract
The aims of this study are to describe tumor characteristics and treatment patterns of elder breast cancer patients and to determine the factors influencing local and systemic treatments. This retrospective cohort included 866 patients (>or=60 years) referred for surgery between January 2002 and December 2006. The patients were divided into four groups according to age. Elderly women had larger tumors at diagnosis with more mucinous carcinomas, more estrogen/progesterone-positive, lower Ki-67 labeling indices and less c-erbB2 positive tumors. Comorbidities were more often recorded for older patients. They were more likely to undergo simple mastectomy or breast-conserving surgery, less likely to receive adjuvant chemotherapy and radiotherapy, compared with their younger counterparts. Multinomial and binary logistic regression showed that age was independently associated with local and systemic treatments. Our data suggest that the tumors of elderly patients are biologically more favorable, and elderly women appear to receive less aggressive treatments.
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Affiliation(s)
- Chuan-Dong Ma
- Department of Breast Surgery, Cancer Hospital, Fudan University, Shanghai 200032, PR China
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Affiliation(s)
- Diana Crivellari
- Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, Aviano, Italy
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Cheung K, Wong A, Parker H, Li V, Winterbottom L, Morgan D, Ellis I. Pathological features of primary breast cancer in the elderly based on needle core biopsies—A large series from a single centre. Crit Rev Oncol Hematol 2008; 67:263-7. [DOI: 10.1016/j.critrevonc.2008.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 01/10/2008] [Accepted: 04/16/2008] [Indexed: 11/29/2022] Open
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Durbecq V, Ameye L, Veys I, Paesmans M, Desmedt C, Sirtaine N, Sotiriou C, Bernard-Marty C, Nogaret J, Piccart M, Larsimont D. A significant proportion of elderly patients develop hormone-dependant “luminal-B” tumours associated with aggressive characteristics. Crit Rev Oncol Hematol 2008; 67:80-92. [DOI: 10.1016/j.critrevonc.2007.12.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 12/11/2007] [Accepted: 12/19/2007] [Indexed: 11/26/2022] Open
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Mannino M, Yarnold JR. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol 2008; 90:14-22. [PMID: 18502528 DOI: 10.1016/j.radonc.2008.05.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 05/01/2008] [Indexed: 11/30/2022]
Abstract
Rates of local tumour relapse after breast conservation treatment in women with early breast cancer are falling. Explanations for this decline are considered in this review including advances in breast cancer management and aging of the breast cancer population. Breast surgery has become more standardised following publication of practice guidelines and is mostly carried out by specialist surgeons. Systemic therapies (hormonal therapy and chemotherapy) are now more effective and are recommended to a higher proportion of patients than ever before. Radiotherapy techniques have also improved. The contributions of each factor are difficult to quantify precisely, but all are likely to be relevant. In order to identify a subgroup of women that might safely be spared radiotherapy, several factors are analysed, including the prognostic significance for local relapse of tumour characteristics (pathologic data, gene-expression profiles), patient characteristics and life expectancy (age and comorbidities).
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Affiliation(s)
- Mariella Mannino
- Royal Marsden Hospital, Department of Clinical Oncology, Surrey, UK
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White S, Stewart JM. Role of Adjuvant Therapy in Older People with Breast Cancer. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2007. [DOI: 10.1002/j.2055-2335.2007.tb00779.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Josephine M Stewart
- Medical Oncologist and Palliative Care Physician, Joint Ludwig-Austin Oncology Unit, Department of Medical Oncology; Austin Hospital; Heidelberg Victoria
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Clinical epidemiology of breast cancer in the elderly. Eur J Cancer 2007; 43:2242-52. [PMID: 17870517 DOI: 10.1016/j.ejca.2007.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 12/27/2022]
Abstract
Breast cancer will increasingly become a disease affecting the lives of older women, especially in more developed countries, the prevalence rising up to 7% over age 70 in the near future. A review of the population-based literature and an analysis of the data of the Eindhoven Cancer Registry and European data regarding the diagnosis, treatment and prognosis showed that the proportion with unstaged and advanced disease (stages III and IV) is higher among elderly patients compared to younger ones and that their treatment is generally less aggressive, although the proportion receiving chemotherapy is increasing since the early 1990s. Disease specific (or relative) survival of elderly breast cancer patients is generally lower and the prevalence of serious (life expectancy affecting) co-morbidity is higher (>50% in patients over age 70). Because of large individual variations in physical and mental conditions, limited evidence from RCTs and personal preferences prevailing in the decision-making process, treatment of older breast cancer patients seems difficult to fit into guidelines. Therefore, alternative research strategies are needed to understand and improve the care for the elderly breast cancer population, such as descriptive (registry-based) studies and a qualitative, individual-based approach.
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Gennari R, Audisio RA. Breast cancer in elderly women. Optimizing the treatment. Breast Cancer Res Treat 2007; 110:199-209. [PMID: 17851758 DOI: 10.1007/s10549-007-9723-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
The elderly population is on the rise. Breast cancer is the most common cancer in western women and its incidence increases with age. Despite the epidemiological burden of this condition, there is a lack of knowledge regarding the management of older patients, as treatment planning is mainly based on personal preferences rather than hard data. Older women are often offered sub-optimal treatment when compared to their younger counterpart at any particular stage. This is due to various reasons, including the lack of scientific evidence from well-conducted clinical trials. Reluctance to prescribe systemic treatments may be explained by the complexity of cost-benefit evaluations in such patients. It is also an ethical dilemma to decide how aggressive one should be when it comes to treat cancer in the elderly in view of the higher rate of cognitive impairment and specific patients' expectations. This paper reviews the currently available evidence and attempts presenting and discussing chemoprevention of breast cancer, risk and benefit of hormone replacement therapy and the various treatment options for older women with breast cancer.
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Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 2007; 43:2179-93. [PMID: 17681780 DOI: 10.1016/j.ejca.2007.06.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/14/2007] [Accepted: 06/20/2007] [Indexed: 12/22/2022]
Abstract
Evidence is scarce about the influence of comorbidity on outcome of surgery, whereas this information is highly relevant for estimating the surgical risk of cancer patients, and for optimising pre-, peri- and postoperative care. In this paper, the prognostic role of increasing age and comorbid conditions in patients diagnosed with stage I-III colorectal, stage I-II NSCLC or stage I-III breast cancer between 1995 and 2004 in the southern part of the Netherlands is summarised. Almost all patients with stage I-III colon cancer or rectal cancer underwent surgery regardless of age or comorbidity. In contrast, the resection rate among elderly patients with stage I-II NSCLC was clearly lower than among younger patients and was significantly lower when COPD, cardiovascular diseases or diabetes were present. Among patients with stage I-III breast cancer, those aged 80 or older underwent less surgery, and the resection rate appeared to be lower when cardiovascular diseases or diabetes were present. Among patients with resected colorectal cancer, postoperative morbidity and mortality were higher among those undergoing emergency surgery, and also among those with reduced pulmonary function, cardiovascular disease or neurological comorbidity. Among those with resected NSCLC, postoperative morbidity and mortality were related to reduced pulmonary function or cardiovascular disease. Since surgery for breast cancer is low risk, elective surgery, morbidity and mortality were not higher for elderly or those with comorbidity. Among patients with colorectal or breast cancer, comorbidity in general, cardiovascular diseases, COPD, diabetes (only colon and breast cancer) and venous thromboembolism had a negative effect on overall survival, whereas the effect of comorbidity on survival of stage I-II NSCLC was less clear. Elderly and those with comorbidity (especially cardiovascular diseases and COPD) among colorectal cancer and NSCLC patients had more postoperative morbidity and mortality. Prospective randomised studies are needed for refining selection criteria for surgery in elderly cancer patients and for anticipation and prevention of complications.
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Crivellari D, Aapro M, Leonard R, von Minckwitz G, Brain E, Goldhirsch A, Veronesi A, Muss H. Breast Cancer in the Elderly. J Clin Oncol 2007; 25:1882-90. [PMID: 17488987 DOI: 10.1200/jco.2006.10.2079] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.
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Affiliation(s)
- Diana Crivellari
- Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, Aviano, PN Italy.
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Abstract
There is a clear association between the development of breast cancer and increasing age, with 80% of cancers occurring in women more than 50 years of age and one-third in women over 70 years. Following the menopause the breast undergoes involution, with the main changes affecting the terminal ductal lobular unit. There is an increase in oestrogen receptor alpha (ERalpha)-positive cells, a decrease in proliferation but, in comparison to premenopausal breasts, a greater number of ERalpha-proliferating cells. The breast cancers that occur in women >/= 75 years are more likely to be ER-positive, with a low growth rate and limited expression of HER-2 and p53. It is proposed that uneven involution of the breast, the persistence of at-risk lesions, the presence of ERalpha-proliferating cells and local oestrogen metabolism in breast adipose tissue are factors in the development of breast cancers with a well-differentiated phenotype.
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Affiliation(s)
- R A Walker
- Breast Cancer Research Unit, Department of Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, UK.
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