1
|
Zhong Y, Wang Z, Xu Y, Zhou Y, Mao F, Shen S, Sun Q. Breast-conserving surgery without axillary surgery and radiation versus mastectomy plus axillary dissection in elderly breast cancer patients: A retrospective study. Front Oncol 2023; 13:1126104. [PMID: 37020865 PMCID: PMC10067658 DOI: 10.3389/fonc.2023.1126104] [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: 12/17/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Background The high relative mortality rate in elderly breast cancer patients is most likely the result of comorbidities rather than the tumor load. Foregoing axillary lymph node dissection or omitting radiotherapy after breast-conserving surgery (BCS) does not affect the prognosis of elderly breast cancer patients. We sought to assess the safety of breast-conserving surgery without axillary lymph node dissection as well as breast and axillary radiotherapy (BCSNR) in elderly patients with early-stage breast cancer. Methods We retrospectively included 541 consecutive breast cancer patients aged over 70 years with clinically negative axillary lymph nodes in one clinical center. Of these patients, 181 underwent mastectomy plus axillary lymph node dissection (MALND) with negative axillary cleaning and 360 underwent BCSNR. Results After a median follow-up of 5 years, there was no significant difference between the BCSNR and MALND groups in either distant recurrence-free survival (DRFS) (p=0.990) or breast cancer-specific survival (p=0.076). Ipsilateral axillary disease was found in 11 (3.1%) patients in the BCSNR group and 3 (1.7%) patients in the MALND group; this difference was not significant (p=0.334). We did not observe a significant difference in distant recurrence between the groups (p=0.574), with 25 (6.9%) patients in the BCSNR group experiencing distant recurrence compared to 15 (8.3%) patients in the MALND group. Our findings did show a significant difference in ipsilateral breast cancer recurrence (IBTR), with 31 (8.6%) patients in the BCSNR group experiencing IBTR compared to only 2 (1.1%) patients in the MALND group (p=0.003). Conclusion BCSNR is a safe treatment option for elderly breast cancer patients with clinically negative axillary lymph nodes.
Collapse
|
2
|
Mortality due to breast cancer in a region of high socioeconomic vulnerability in Brazil: Analysis of the effect of age-period and cohort. PLoS One 2021; 16:e0255935. [PMID: 34388198 PMCID: PMC8362978 DOI: 10.1371/journal.pone.0255935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Breast cancer is an important public health problem worldwide, with important disparities in incidence, mortality, and survival rates between developed and developing countries due to inequalities regarding access to measures for the prevention and treatment of the disease. In Brazil, there are higher rates of incidence and a downward trend in mortality in regions of greater socioeconomic development. Objective To evaluate the effect of age, period, and birth cohort on breast cancer mortality in women aged 20 years and older in the states of the Northeast Region of Brazil, an area of high socioeconomic vulnerability, from 1980 to 2019. Methods The death records were extracted from the DATASUS Mortality Information System website (Department of National Health Informatics) from the Ministry of Health of Brazil. Estimable functions were used to estimate the age-period and cohort models (APC) using the Epi library from the R statistical software version 6.4.1. Results The average breast cancer mortality rate for the period was 20.45 deaths per 100,000 women. The highest coefficients per 100,000 women were observed in the states of Pernambuco (21.09 deaths) and Ceará (20.85 deaths), and the lowest in Maranhão (13.58 deaths) and Piauí (15.43 deaths). In all of the locations, there was a progressive increase in mortality rates in individuals over 40 years of age, with higher rates in the last five-year period (2015–2019). There was an increase in the risk of death for the five-year period of the 2000s in relation to the reference period (1995–1999) in the Northeast region and in the states of Alagoas, Bahia, Maranhão, Paraíba, and Piauí. In addition, there was an increased risk of death for women born after the 1950s in all locations. Conclusion The highest mortality rates in all five-year periods analyzed were observed in states with greater socioeconomic development, with an increase in mortality rates in the 2000s, and a higher risk of death in the younger cohorts.
Collapse
|
3
|
Hill A, Gutierrez E, Liu J, Sammons S, Kimmick G, Sedrak MS. The Evolving Complexity of Treating Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2 (HER2)-Negative Breast Cancer: Special Considerations in Older Breast Cancer Patients-Part II: Metastatic Disease. Drugs Aging 2020; 37:349-358. [PMID: 32227289 DOI: 10.1007/s40266-020-00758-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Breast cancer is a disease of aging, and the incidence of breast cancer is projected to increase dramatically as the global population ages. The majority of breast cancers that occur in older adults are hormone-receptor positive, human epidermal growth factor receptor-2 (HER2)-negative phenotypes, with favorable tumor biology; yet, because of underrepresentation in clinical trials, less evidence is available to guide the complex care for this population. Providing care for older patients with metastatic breast cancer, with coexisting medical conditions, increased risk of treatment toxicity, and frailty, remains a clinical challenge in oncology. In this review, we provide an overview of the current evidence from clinical trials and subanalyses of older adults with hormone receptor-positive, HER2-negative metastatic breast cancer, highlighting data on the safety and efficacy of oral therapies, including endocrine therapy alone or in combination with cyclin-dependent kinase (CDK) 4/6 inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, and mammalian target of rapamycin (mTOR) inhibitors. In addition, we note the significant underrepresentation of older and frail adults in these studies. Current and future directions in research for this special population, in order to address significant knowledge gaps, include the need to improve long-term adherence to hormonal and targeted therapy, prospective clinical trials that capture clinical and biological aging endpoints, and the need for a multidisciplinary approach with integration of geriatric and oncology principles.
Collapse
Affiliation(s)
- Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Eutiquio Gutierrez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Sarah Sammons
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Gretchen Kimmick
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| |
Collapse
|
4
|
Outcomes of primary endocrine therapy in elderly women with stage I-III breast cancer: a SEER database analysis. Breast Cancer Res Treat 2020; 180:819-827. [PMID: 32172303 DOI: 10.1007/s10549-020-05591-9] [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: 01/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Frail elderly women with nonmetastatic hormone receptor-positive breast cancer often receive primary endocrine therapy. Limited data are available on the outcomes associated with this population and treatment approach. METHODS We selected patients with an initial primary diagnosis of stage I-III ER-positive breast cancer from 2001 to 2015 in Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Patients were excluded if they received surgery, radiation, chemotherapy, or other targeted drug treatment including anti-HER2 agents. Two Cox proportional-hazards models were constructed to determine the predictors of breast cancer-specific survival and overall survival after a cancer diagnosis. RESULTS A total of 552 patients were identified, with 82.1% of the patients being 80 years or older and 81.7% of patients being non-Hispanic White. PR positive (OR 1.77; 95% CI 1.09-2.85; p = 0.025) and tumor size larger than 50 mm (OR 1.99; 95% CI 1.05-3.75; p = 0.035) were associated with higher adherence to endocrine therapy. In the multivariable Cox analyses, patients who were adherent of endocrine therapy had significantly worse survival (HR 1.40; 95% CI 1.17-1.69; p < 0.001). The other two factors associated with worse survival were larger tumor size and more comorbidities. The competing risk model demonstrated no statistically significant difference between patients who were adherent to endocrine therapy and those who were not in terms of risk of dying from breast cancer. CONCLUSION In elderly women with localized ER-positive breast cancer, there were no statistically significant differences in breast cancer-specific or overall mortality between those who were adherent to endocrine therapy and those who were not.
Collapse
|
5
|
Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review. Eur J Cancer 2020; 127:191-206. [PMID: 31932175 DOI: 10.1016/j.ejca.2019.12.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to quantify the impact of organised mammography screening on breast cancer mortality across European regions. Therefore, a systematic review was performed including different types of studies from all European regions and stringently used clearly defined quality appraisal to summarise the best evidence. METHODS Six databases were searched including Embase, Medline and Web of Science from inception to March 2018. To identify all eligible studies which assessed the effect of organised screening on breast cancer mortality, two reviewers independently applied predefined inclusion and exclusion criteria. Original studies in English with a minimum follow-up of five years that were randomised controlled trials (RCTs) or observational studies were included. The Cochrane risk of bias instrument and the Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS Of the 5015 references initially retrieved, 60 were included in the final analysis. Those comprised 36 cohort studies, 17 case-control studies and 7 RCTs. None were from Eastern Europe. The quality of the included studies varied: Nineteen of these studies were of very good or good quality. Of those, the reduction in breast cancer mortality in attenders versus non-attenders ranged between 33% and 43% (Northern Europe), 43%-45% (Southern Europe) and 12%-58% (Western Europe). The estimates ranged between 4% and 31% in invited versus non-invited. CONCLUSION This systematic review provides evidence that organised screening reduces breast cancer mortality in all European regions where screening was implemented and monitored, while quantification is still lacking for Eastern Europe. The wide range of estimates indicates large differences in the evaluation designs between studies, rather than in the effectiveness of screening.
Collapse
|
6
|
de Kruif JTCM, Scholtens MB, van der Rijt J, de Boer MR, van den Berg MMGA, de Vries YC, Winkels RM, Visser M, Kampman E, Westerman MJ. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer 2018; 27:601-607. [PMID: 30022349 PMCID: PMC6325997 DOI: 10.1007/s00520-018-4347-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
Purpose Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy. Methods A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians. Results To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs’ training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy. Conclusion More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.
Collapse
Affiliation(s)
- J Th C M de Kruif
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - M B Scholtens
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J van der Rijt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M R de Boer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Y C de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - R M Winkels
- Penn State Cancer Institute, Department of Public Health Sciences, Penn State University, Hershey, PA, USA
| | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - M J Westerman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Rottenberg Y, Naeim A, Uziely B, Peretz T, Jacobs JM. Breast cancer among older women: The influence of age and cancer stage on survival. Arch Gerontol Geriatr 2018; 76:60-64. [PMID: 29459246 DOI: 10.1016/j.archger.2018.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY To describe the association between increasing age and survival among women aged over 65 years, diagnosed with breast cancer. MATERIALS AND METHODS A historical prospective cohort study, comparing 3270 breast cancer patients to 13,163 non cancer age matched controls. Baseline characteristics and cancer data gathered from the Israeli Central Bureau of Statistics (1995), the Israel Cancer Registry (2000-2010). Baseline measurements included age, socioeconomic status. Cancer stage at diagnosis was clustered as stage I, stage II-III and metastatic. Cox Proportional Hazards regression models were used to determine Hazards Ratios (HR) for mortality. RESULTS Between ages 65-69 and ≥85, metastatic disease rose from 3.9% to 23.4% and stage I disease declined from 58.6% to 30.1%. At age 80-84, 50% life expectancy among controls, stage I, and stage II-III disease was 95,92 and 90 months respectively, compared to 2 months for metastatic disease. Compared to controls, between the age 65-69 to ≥85, adjusted HR's progressively decreased among subjects with stage I from HR 0.96 (95% CI 0.69-1.33) to 0.60 (95%CI 0.36-1.01), stage II-III from HR 3.26 (95%CI2.58-4.12) to HR 1.60 (95%CI 1.22-2.09), and metastatic disease from HR 57.40 (95%CI 39.56-83.29) to HR 20.76 (95%CI 14.73-29.24). CONCLUSIONS This study describes the increasingly poor prognosis and short life expectancy observed among women aged ≥80 diagnosed with metastatic breast. In contrast, our findings confirm the positive prognosis associated with rising age, among older women presenting with stage I breast cancer, among whom survival was similar, if not slightly better, than non-cancer age matched controls.
Collapse
Affiliation(s)
- Yakir Rottenberg
- The Department of Oncology, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel; The Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center Mount Scopus, Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel.
| | - Arash Naeim
- Divisions of Hematology-Oncology and Geriatric Medicine, Department of Medicine and Jonsson Comprehensive Cancer Center, David Geffen UCLA School of Medicine, 10911 Weyburn Avenue, Los Angeles, CA 90095, United States
| | - Beatrice Uziely
- The Department of Oncology, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Tamar Peretz
- The Department of Oncology, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Jeremy M Jacobs
- The Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center Mount Scopus, Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel; The Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center Mount Scopus, Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel.
| |
Collapse
|
8
|
Adhami M, Haghdoost AA, Sadeghi B, Malekpour Afshar R. Candidate miRNAs in human breast cancer biomarkers: a systematic review. Breast Cancer 2017; 25:198-205. [PMID: 29101635 DOI: 10.1007/s12282-017-0814-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Breast cancer (BC) is the most prevalent cancer and the main cause of cancer deaths among females around the world. For early diagnosis of BC, there would be an immediate and essential requirement to search for sensitive biomarkers. METHODS To identify candidate miRNA biomarkers for BC, we performed a general systematic review regarding the published miRNA profiling researches comparing miRNA expression level between BC and normal tissues. A miRNA ranking system was selected, which considered frequency of comparisons in direction and agreement of differential expression. RESULTS We determined that two miRNAs (mir-21 and miR-210) were upregulated consistently and six miRNAs (miR-145, miR-139-5p, miR-195, miR-99a, miR-497 and miR-205) were downregulated consistently in at least three studies. MiR-21 as the most consistently reported miRNA was upregulated in six profiling studies. CONCLUSIONS Although these miRNAs require being validated and further investigated, they could be potential candidates for BC miRNA biomarkers and used for early prognosis or diagnosis.
Collapse
Affiliation(s)
- Masoumeh Adhami
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Balal Sadeghi
- Food Hygiene and Public Health Department, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran.
| | - Reza Malekpour Afshar
- Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
9
|
Routine treatment and outcome of breast cancer in younger versus elderly patients: results from the SENORA project of the prospective German TMK cohort study. Breast Cancer Res Treat 2017; 167:567-578. [PMID: 29030786 PMCID: PMC5790852 DOI: 10.1007/s10549-017-4534-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/06/2017] [Indexed: 11/06/2022]
Abstract
Purpose There is an ongoing discussion about ‘undertreatment’ of breast cancer in elderly patients. Due to low accrual into clinical trials, level 1 evidence is scarce. We report prospective data of elderly patients with breast cancer treated by medical oncologists in Germany. Methods The SENORA project within the prospective cohort study TMK (Tumour Registry Breast Cancer) was conducted in 82 centres from 2007–2015. Among 2316 patients, half were enrolled with curative and half with palliative treatment intention. Overall, 478 patients (21%) were aged ≥ 70. Results In the adjuvant setting, elderly patients aged ≥ 70 had more advanced tumour stages at diagnosis and a higher prevalence of comorbidities than younger patients. Elderly patients received adjuvant chemotherapy less frequently, yet the 3-year disease-free survival was similar (86% vs. 88%). In the palliative setting, elderly patients more frequently received endocrine therapy and less frequently chemotherapy. Their median overall survival [24.9 months, 95% CI (confidence interval) 20.0–30.2] was significantly shorter than that of younger patients (39.7 months, 95% CI 34.9–44.2). A Cox proportional hazards model showed a significantly increased risk of mortality for: age ≥ 70 at start of therapy, negative HR- or HER2-status, higher number of metastatic sites, more comorbidities and high tumour grading at diagnosis. Conclusions Our results shed light on the routine treatment of elderly patients with breast cancer. A regression model demonstrated that age is but one of various prognostic factors determining the shorter overall survival of elderly patients.
Collapse
|
10
|
Abstract
Aging poses an unique opportunity to study cancer biology and treatment in older adults. Breast cancer is often studied in young women; however, much investigation remains to be done on breast cancer in our expanding elderly population. Diagnostic and management strategies applicable to younger patients cannot be empirically used to manage older breast cancer patients. Lack of evidence-based data continues to be the major impediment toward delivery of personalized cancer care to elderly breast cancer patients. This article reviews the relevant literature on management of curable breast cancer in the elderly, the role of geriatric assessment, complex treatment decision making within the context of patient's expected life expectancy, comorbidities, physical function, socioeconomic status, barriers to health care delivery, goals of treatment, and therapy-related side effects. Continuing efforts for enrolling elderly breast cancer patients in contemporary clinical trials, and thus improving age-appropriate care, are emphasized.
Collapse
|
11
|
Meresse M, Bouhnik AD, Bendiane MK, Retornaz F, Rousseau F, Rey D, Giorgi R. Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment? Breast J 2016; 23:256-266. [DOI: 10.1111/tbj.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mégane Meresse
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Frédérique Retornaz
- Departemental Geriatric Center; Polyvalent Geriatric Center; Marseille France
- Unit of Care and Research in Internal Medicine; Hôpital Européeen; Marseille France
| | - Frédérique Rousseau
- Pilot Unit of Research and Coordination in Geriatric Oncology; Department of Medicine; Institut Paoli-Calmettes; Marseille France
| | - Dominique Rey
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Roch Giorgi
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- Biostatistics & Information and Communication Technology Unit; APHM Timone hospital; Marseille France
| |
Collapse
|
12
|
Cardiac toxicity of trastuzumab in elderly patients with breast cancer. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:355-63. [PMID: 27403145 PMCID: PMC4921548 DOI: 10.11909/j.issn.1671-5411.2016.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Breast cancer (BC) is diagnosed in ≥ 65 year old women in about half of cases. Experts currently recommend that systemic therapy is offered to elderly patients with BC, if, based on their overall conditions and life expectancy, it can be reasonably anticipated that the benefits will outweigh the risks of treatment. Like for young subjects, the monoclonal antibody against human epidermal growth factor receptor-2 (HER-2), trastuzumab, represents a valid therapeutic option when BC over-expresses this receptor. Unfortunately, administration of trastuzumab is associated with the occurrence of left ventricular dysfunction and chronic heart failure (CHF), possibly because of interference with the homeostatic functions of HER-2 in the heart. Registry-based, retrospective analyses have reported an incidence of CHF around 25% in elderly women receiving trastuzumab compared with 10%-15% in those not given any therapy for BC, and the risk of CHF has been estimated to be two-fold higher in > 60-65 year old trastuzumab users vs. non-users. Extremely advanced age and preexisting cardiac disease have been shown to predispose to trastuzumab cardiotoxicity. Therefore, selection of older patients for treatment with trastuzumab should be primarily based on their general status and the presence of comorbidities; previous chemotherapy, especially with anthracyclines, should be also taken into account. Once therapy has started, efforts should be made to ensure regular cardiac surveillance. The role of selected biomarkers, such as cardiac troponin, or new imaging techniques (three-dimension, tissue Doppler echocardiography, magnetic resonance imaging) is promising, but must be further investigated especially in the elderly. Moreover, additional studies are needed in order to better understand the mechanisms by which trastuzumab affects the old heart.
Collapse
|
13
|
Short-course radiotherapy in elderly women with breast cancer: Comparison by age, comorbidity index and toxicity. Int J Surg 2016; 33 Suppl 1:S92-6. [PMID: 27255134 DOI: 10.1016/j.ijsu.2016.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy amongst elderly women. It represents the main cause of mortality for those women and it is steadily increasing. The primary therapeutic approach remains surgery, as in other age groups. The role of radiotherapy following surgery is still debated. The use of hypofractionated schedules is challenging the standard fractionation and has now been considered an advantageous option within this subgroup of patients. Results from randomized controlled trials have not been shown to be inferior to standard fractionation in terms of local recurrence, disease-free survival and overall survival. Acute and late side effects were not increased by hypofractionated regimens. PATIENTS AND METHODS 60 elderly women treated by hypofractionated radiotherapy after breast conserving surgery were stratified by age. Comorbidities associated compliance and toxicity correlation to age were the first endpoints of the study. Comorbidity associated compliance was calculated by Cumulative Illness Rating Scale Geriatric. RESULTS At a median follow-up of 15 months overall survival was 100%, without severe late toxicity. No statistical significant differences were found between Cumulative Illness Rating Scale-Geriatric, systemic therapy and toxicity. CONCLUSION In our experience hypofractioned regimens seem to be safe and reliable in the elderly setting, although longer follow up is needed.
Collapse
|
14
|
Biganzoli L, Aapro M, Loibl S, Wildiers H, Brain E. Taxanes in the treatment of breast cancer: Have we better defined their role in older patients? A position paper from a SIOG Task Force. Cancer Treat Rev 2016; 43:19-26. [DOI: 10.1016/j.ctrv.2015.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|
15
|
|
16
|
Madsen MT, Huang C, Gögenur I. Actigraphy for measurements of sleep in relation to oncological treatment of patients with cancer: A systematic review. Sleep Med Rev 2015; 20:73-83. [DOI: 10.1016/j.smrv.2014.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
|
17
|
Huang C, Madsen MT, Gögenur I. Circadian rhythms measured by actigraphy during oncological treatments: a systematic review. BIOL RHYTHM RES 2015. [DOI: 10.1080/09291016.2015.1004840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
18
|
Rasmussen CB, Kjær SK, Ejlertsen B, Andersson M, Jensen MB, Christensen J, Langballe R, Mellemkjær L. Incidence of metachronous contralateral breast cancer in Denmark 1978–2009. Int J Epidemiol 2014; 43:1855-64. [DOI: 10.1093/ije/dyu202] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
19
|
Holleczek B, Brenner H. Provision of breast cancer care and survival in Germany - results from a population-based high resolution study from Saarland. BMC Cancer 2014; 14:757. [PMID: 25304931 PMCID: PMC4213502 DOI: 10.1186/1471-2407-14-757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Studies on the implementation of Clinical Practice Guidelines (CPG) and particularly its effect on breast cancer (BRC) survival on a population-level are scant. This population-based high resolution study from Germany aims at providing data on the usage of BRC treatment, the extent of adherence to CPG and, as a novelty, survival of BRC patients according to major recommended treatment options. METHODS Data from the Saarland Cancer Registry including women diagnosed with invasive BRC without distant metastasis and followed up between 2000 and 2009 were used. Provision of cancer care according to major treatment options is presented by age, clinical subtypes of BRC, and over time. Conventional and modeled period analysis was used to derive estimates of most up-to-date 5-year relative survival (RS) and the effect of non-adherence to CPG on relative excess risk of death (RER). RESULTS The study revealed increasing guideline adherence, with high levels already seen for local treatment (e.g. 67% of the BRC patients in 2008/09 received breast conserving surgery), and substantial progress since the millennium change with regard to sentinel node dissection (SND) and adjuvant systemic treatments (e.g. SND and chemotherapy provided to 62% of all patients and 79% of the patients with nodal positive or hormone receptor negative BRC in 2008/09, respectively). It further demonstrated increased cancer related mortality among patients without guideline compliant cancer treatment (e.g. patients with nodal positive and hormone receptor negative BRC who were not treated with chemotherapy had a 5-year RS of 29% (RER: 2.89, 95% CI: 1.46-5.71) compared to 54% for patients obtaining chemotherapy). CONCLUSIONS This study provides data on the implementation of CPG in a highly developed European country and extends available population-based survival data of BRC patients and may provide evidence of increased cancer related excess mortality, if BRC patients do not receive guideline compatible treatment.
Collapse
Affiliation(s)
- Bernd Holleczek
- />Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- />Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119 Saarbrücken, Germany
| | - Hermann Brenner
- />Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- />German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| |
Collapse
|
20
|
Reginelli A, Calvanese M, Ravo V, Di Franco R, Silvestro G, Gatta G, Squillaci E, Grassi R, Cappabianca S. Management of breast cancer in elderly patients. Int J Surg 2014; 12 Suppl 2:S187-S192. [DOI: 10.1016/j.ijsu.2014.08.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
|
21
|
Krilaviciute A, Smailyte G, Brenner H, Gondos A. Cancer survival in Lithuania after the restoration of independence: rapid improvements, but persisting major gaps. Acta Oncol 2014; 53:1238-44. [PMID: 24669773 DOI: 10.3109/0284186x.2014.888495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Following restoration of political independence in 1990, Lithuania underwent rapid societal and economic changes. We aimed to assess trends in cancer survival in the first two decades following these changes. MATERIAL AND METHODS We used population-based data from the Lithuanian Cancer Registry and period analysis techniques to examine trends in one-, 2-5- and five-year relative survival between 1995-1999 and 2005-2009 for 24 common cancers in Lithuania. RESULTS Between 1995-1999 and 2005-2009, five-year relative survival increased significantly for 20 of 24 cancers, and for 10 cancers the increase exceeded 10% units. Five-year relative survival estimates reached 46%, 69% and 91% for colorectal, breast and prostate cancer in 2005-2009, respectively, while patients with testicular cancer, Hodgkin's or non-Hodgkin's lymphoma had a five-year relative survival of 77%, 75% and 50%, respectively. CONCLUSION We found a rapid increase in survival for most forms of common cancers in Lithuania between 1995 and 2009. Nevertheless, several cancers with effective therapies exhibit considerable gaps compared with Northern and Western European countries. Despite ongoing rises in survival, mortality declines are not yet manifesting for important common cancers such as breast and colorectal cancer. Rapid incidence rises suggest that increases in survival for prostate and thyroid cancers are massively influenced by early detection-related effects. Improving the availability of effective therapies, and carefully planned early detection programs may help to increase cancer survival in Lithuania in the future.
Collapse
Affiliation(s)
- Agne Krilaviciute
- Lithuanian Cancer Registry, Institute of Oncology, Vilnius University , Vilnius , Lithuania
| | | | | | | |
Collapse
|
22
|
De Cocker K, Charlier C, Van Hoof E, Pauwels E, Lechner L, Bourgois J, Spittaels H, Vandelanotte C, De Bourdeaudhuij I. Development and usability of a computer-tailored pedometer-based physical activity advice for breast cancer survivors. Eur J Cancer Care (Engl) 2014; 24:673-82. [DOI: 10.1111/ecc.12225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. De Cocker
- Department of Movement and Sport Sciences; Ghent University; Ghent Belgium
- Research Foundation Flanders; Brussels Belgium
| | - C. Charlier
- Department of Movement and Sport Sciences; Ghent University; Ghent Belgium
- School of Psychology; Open University of the Netherlands; Heerlen the Netherlands
| | - E. Van Hoof
- Experimental and Applied Psychology; Free University of Brussels; Brussels Belgium
| | - E. Pauwels
- Department of Movement and Sport Sciences; Ghent University; Ghent Belgium
| | - L. Lechner
- School of Psychology; Open University of the Netherlands; Heerlen the Netherlands
| | - J. Bourgois
- Department of Movement and Sport Sciences; Ghent University; Ghent Belgium
| | | | - C. Vandelanotte
- Institute for Health and Social Science Research; Central Queensland University; Rockhampton Qld Australia
| | | |
Collapse
|
23
|
Metin Seker M, Yucel B, Seker A, Ay Eren A, Bahar S, Celasun G, Kacan T, Fuat Eren M, Babacan N, Bahceci A. Treatment and prognosis of breast cancer in elderly: Different from young patients? Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Loibl S, Reinisch M. Present status of adjuvant chemotherapy for elderly breast cancer patients. ACTA ACUST UNITED AC 2014; 7:439-44. [PMID: 24715824 DOI: 10.1159/000345867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Elderly breast cancer patients are underrepresented in clinical trials, leading to a lack of knowledge regarding their tolerance of modern chemotherapy regimens. In addition, physicians are often reluctant to treat older patients with chemotherapy due to potential side effects. This article summarizes the up-to-date literature on chemotherapy in elderly patients with breast cancer, evaluates the impact of the patients' comorbidities and treatment alterations and aims to encourage treating patients adequately according to their disease in combination with the biological age rather than the chronological age alone. Finally, a short overview is given of the recruiting studies in Europe evaluating chemotherapy in elderly patients.
Collapse
Affiliation(s)
- Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany ; Städtische Kliniken Offenbach, Germany
| | - Mattea Reinisch
- German Breast Group, Neu-Isenburg, Germany ; Frauenklinik, Bürgerhospital Frankfurt/M., Germany
| |
Collapse
|
25
|
Pharmacological treatment of depression in women with breast cancer: a systematic review. Breast Cancer Res Treat 2013; 141:325-30. [DOI: 10.1007/s10549-013-2708-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/19/2013] [Indexed: 01/06/2023]
|
26
|
Allemani C, Minicozzi P, Berrino F, Bastiaannet E, Gavin A, Galceran J, Ameijide A, Siesling S, Mangone L, Ardanaz E, Hédelin G, Mateos A, Micheli A, Sant M. Predictions of survival up to 10 years after diagnosis for European women with breast cancer in 2000-2002. Int J Cancer 2013; 132:2404-12. [PMID: 23047687 DOI: 10.1002/ijc.27895] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 09/03/2012] [Indexed: 11/09/2022]
Abstract
Few studies have addressed longer-term survival for breast cancer in European women. We have made predictions of 10-year survival for European women diagnosed with breast cancer in 2000-2002. Data for 114,312 adult women (15-99 years) diagnosed with a first primary malignant cancer of the breast during 2000-2002 were collected in the EUROCARE-4 study from 24 population-based cancer registries in 14 European countries. We estimated relative survival at 1, 5, and 10 years after diagnosis for women who were alive at some point during 2000-2002, using the period approach. We also estimated 10-year survival conditional on survival to 1 and 5 years after diagnosis. Ten-year survival exceeded 70% in most regions, but was only 54% in Eastern Europe, with the highest value in Northern Europe (about 75%). Ten-year survival conditional on survival for 1 year was 2-6% higher than 10-year survival in all European regions, and geographic differences were smaller. Ten-year survival for women who survived at least 5 years was 88% overall, with the lowest figure in Eastern Europe (79%) and the highest in the UK (91%). Women aged 50-69 years had higher overall survival than older and younger women (79%). Six cancer registries had adequate information on stage at diagnosis; in these jurisdictions, 10-year survival was 89% for local, 62% for regional and 10% for metastatic disease. Data on stage are not collected routinely or consistently, yet these data are essential for meaningful comparison of population-based survival, which provides vital information for improving breast cancer control.
Collapse
Affiliation(s)
- Claudia Allemani
- Analytical Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
In recent years a growing amount of data on prognostic features of breast cancer has allowed for identification of tumors with a very low risk of recurrence. Markers used to predict the risk of distant spread include classic clinicopathologic features as well as newer tumor gene signatures, which have been validated and are being used in cohorts of patients with breast cancer patients who have low-risk disease. However, the definition of "low-risk" breast cancer requires consideration of patient-related factors such as comorbidities and age in addition to tumor characteristics, as high competing risks for mortality might be more important than cancer recurrence from a patient's point of view. In addition, identification of low-risk breast cancer cohorts is only valuable if treatment decisions are based on this information. Therefore, the magnitude of any treatment benefit in low-risk disease needs to be quantified in a comprehensible way. However, treatment benefit in low-risk situations is hard to quantify, may vary over time, and needs to be compared to individual risks for side effects. Decision models considering tumor and patient characteristics as well as predictive markers for treatment efficacy and toxicity will be needed. Tools such as Adjuvant! Online ultimately need to include information from gene signatures in order to reliably recommend specific treatment options for patients with breast cancer patients who have low-risk disease.
Collapse
Affiliation(s)
- Kathrin Strasser-Weippl
- From the Harvard Medical School and Avon Breast Cancer Center of Excellence, Massachusetts General Hospital Cancer Center, Boston, MA; Center for Oncology, Hematology and Palliative Care, Vienna, Austria
| | | |
Collapse
|
28
|
Factors affecting 5- and 10-year survival of women with breast cancer: An analysis based on a public general hospital in Barcelona. Cancer Epidemiol 2012; 36:554-9. [DOI: 10.1016/j.canep.2012.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/03/2012] [Accepted: 07/08/2012] [Indexed: 11/23/2022]
|
29
|
Pulte D, Redaniel MT, Brenner H, Jeffreys M. Changes in survival by ethnicity of patients with cancer between 1992-1996 and 2002-2006: is the discrepancy decreasing? Ann Oncol 2012; 23:2428-2434. [PMID: 22396445 DOI: 10.1093/annonc/mds023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patients of minority race/ethnicity have lower survival after diagnosis with most types of cancer. Little data are available concerning changes in disparity over time. Here, we examine changes in survival by race/ethnicity of patients with common cancers in two recent time periods. PATIENTS AND METHODS We used modeled period analysis to determine relative survival (RS) for non-Hispanic white (nHw), African-American (AA), and Hispanic patients in the Surveillance, Epidemiology, and End Results database diagnosed with common solid and hematological malignancies. RESULTS Five-year RS improved overall and for nHw for each tumor examined, ranging from + 2% points (pancreatic cancer) to + 16.4% points [non-Hodgkin's lymphoma, (NHL)]. Greater improvement was observed for AA and Hispanics than nHw in breast and prostate cancer and NHL. Less improvement was observed for AA and Hispanics than for nHw for lung and pancreatic cancer. No statistically significant improvement was observed for AA and Hispanics with myeloma or acute leukemia. Survival disparities ranging from 0.5% points (myeloma) to 13.1% points (breast) between nHw and AA remained. CONCLUSIONS Progress has been made in decreasing disparities in survival between nHw and minorities in breast cancer, prostate cancer, and NHL. Little progress has been made in reducing disparities for the other studied cancers.
Collapse
Affiliation(s)
- D Pulte
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, USA.
| | - M T Redaniel
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - M Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
30
|
Holleczek B, Brenner H. Trends of population-based breast cancer survival in Germany and the US: decreasing discrepancies, but persistent survival gap of elderly patients in Germany. BMC Cancer 2012; 12:317. [PMID: 22838641 PMCID: PMC3522526 DOI: 10.1186/1471-2407-12-317] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 07/18/2012] [Indexed: 01/07/2023] Open
Abstract
Background Studies have revealed both higher cancer survival in the US than in Germany and substantial improvement of cancer survival in the past in these countries. This population-based study aims at comparing most recent 5-year relative survival of breast cancer patients and preceding trends in both countries. Methods Women with a first invasive breast cancer diagnosed and followed up between 1988 and 2008 from Germany and the US (utilizing data from the Saarland Cancer Registry and the Surveillance, Epidemiology, and End Results Program, respectively) were included. Period analysis was used to derive most up-to-date 5-year relative survival and preceding survival trends according to age and stage. Results Since 1993, age standardized relative survival has steadily improved in Germany and the US to 83% and 88%, respectively. In the period 2005–08, relative survival of localized cancer was above 97% in both countries, and 79% and 83% for locally/regionally spread breast cancer, respectively. Prognosis of metastasized disease has remained very poor overall, with improvement essentially being restricted to younger patients. The proportion of patients diagnosed with localized breast cancer was consistently higher in the US. If adjusted for stage, the differences in relative survival between both countries diminished over time and eventually disappeared. Conclusions Similar survival is now observed in both countries for patients below the age of 70 years, but in Germany survival is still much lower for elderly patients. The observed trends point to treatment advances as a major cause for improved survival. However, substantial differences in mammography usage existed between both countries and might probably also account for the observed differences (to a lesser extent, also differences in health care systems, and delivery of cancer care). Encouraging, survival of breast cancer patients has improved in Germany to a much greater extent than in the US, albeit the persisting survival gap for elderly patients in Germany requires particular attention by researchers, public health authorities, and clinicians.
Collapse
Affiliation(s)
- Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
| | | |
Collapse
|
31
|
Kanapuru B, Ershler WB, Hesdorffer C, Jemal A, Yates JW. Long-term survival of older breast cancer patients: population-based estimates over three decades. Breast Cancer Res Treat 2012; 134:853-7. [DOI: 10.1007/s10549-012-2115-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 05/26/2012] [Indexed: 11/29/2022]
|
32
|
Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 2012; 13:e148-60. [PMID: 22469125 DOI: 10.1016/s1470-2045(11)70383-7] [Citation(s) in RCA: 394] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.
Collapse
Affiliation(s)
- Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Istituto Toscano Tumori, Hospital of Prato, Prato, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 2012; 36:237-48. [PMID: 22459198 DOI: 10.1016/j.canep.2012.02.007] [Citation(s) in RCA: 458] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/22/2012] [Accepted: 02/26/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes. RESULTS Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies. CONCLUSION The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly "westernised" lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.
Collapse
Affiliation(s)
- Danny R Youlden
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Qld 4004, Australia.
| | | | | | | | | | | |
Collapse
|
34
|
Charlier C, Van Hoof E, Pauwels E, Lechner L, Spittaels H, De Bourdeaudhuij I. The contribution of general and cancer-related variables in explaining physical activity in a breast cancer population 3 weeks to 6 months post-treatment. Psychooncology 2011; 22:203-11. [PMID: 22052746 DOI: 10.1002/pon.2079] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 08/23/2011] [Accepted: 08/25/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Physical activity determinants are subject to change when confronted with the diagnosis of 'cancer' and new cancer-related determinants appear. The aim of the present study is to compare the contribution of cancer-related determinants with more general ones in explaining physical activity 3 weeks to 6 months post-treatment. METHODS A theory-based and validated questionnaire was used to identify physical activity levels (total and domain-specific) and associated determinants among 464 breast cancer survivors (aged 18 to 65 years) 3 weeks to 6 months post-treatment. RESULTS Descriptive analyses showed higher scores for general determinants in comparison with cancer-related determinants. Nevertheless, regression analyses showed that both general and cancer-related determinants explained total and domain-specific physical activity. Self-efficacy, enjoyment, social support, lack of time and lack of company were important general determinants. The perception of returning to normal life, cancer-related barriers (fatigue, lack of energy and physical side effects) and self-efficacy in overcoming these barriers were important cancer-related determinants. Although results differed according to the women's working status and the physical activity domain, general self-efficacy explained most physical activity types in both groups. CONCLUSION Comparable with the general population, enhancing breast cancer survivors' self-efficacy in being sufficiently physically active seems to be important in physical activity interventions post-treatment. However, interventions should be tailored to the experienced symptoms and working status of the women.
Collapse
Affiliation(s)
- Caroline Charlier
- Faculty of Medicine and Health Sciences, Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | | | | | | | | | | |
Collapse
|