1
|
Beaubrun-Renard MM, Veronique-Baudin J, Macni J, Ulric-Gervaise S, Almont T, Aline-Fardin A, Grossat N, Furtos C, Escarmant P, Vinh-Hung V, Bougas S, Cabie A, Joachim C. Overall survival of triple negative breast cancer in French Caribbean women. PLoS One 2022; 17:e0271966. [PMID: 36001624 PMCID: PMC9401158 DOI: 10.1371/journal.pone.0271966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
To describe survival according to prognostic factors of women with breast cancer in French overseas territory (Martinique) during 2008–2017. We performed a Cox model for prognostic factors for OS in breast cancer patients. The cut-off date for the analysis was 13/10/2018. The main factors were demographic data, stage, hormone receptors (HR) status and HER2 status. Curves were compared with the log rank test to select candidate variables for the multivariate analysis. We included 1,708 patients; median age at diagnosis was 57 years. Triple negative breast cancer (TNBC) accounted for 20.9% (n = 332). Among the patients, 72.3% (n = 1015) had localised or local spread cancer. One-year OS was 95.2% and was 80.1% at 5 years. In TNBC, 1-year-survival was 90.4%, which fell to 70.1% at 5 years. Patients with metastatic disease at diagnosis had 1-year-survival of 74.5%, and 20.1% at 5 years. Multivariate analysis by Cox regression identified 4 factors significantly associated with an increased risk of death: metastatic disease at diagnosis (hazard ratio (HR) = 15, p<0.0001), TNBC (HR 2.84, p<0.0001), HR+/HER2- status (HR 2.05, p<0.0084) and age >75 years (HR 3.8, p<0.0001). This is the first study performed on breast cancer survival in Martinique. Our findings show that breast cancer has overall good prognosis in patients and also how prognosis factors are distributed in the population.
Collapse
Affiliation(s)
- Murielle Murielle Beaubrun-Renard
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
- PCCEI, Université de Montpellier, INSERM, EFS, Université Antilles, Montpellier, France
- * E-mail:
| | - Jacqueline Veronique-Baudin
- UF 3596 Recherche en cancérologie hématologie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Jonathan Macni
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Stephen Ulric-Gervaise
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Thierry Almont
- UF 3596 Recherche en cancérologie hématologie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Aude Aline-Fardin
- Laboratoire d’anatomopathologie, Pôle de Biologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Nathalie Grossat
- UF 1450 - Oncologie Médicale Hospitalisation de Semaine, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Cristina Furtos
- UF 1450 - Oncologie Médicale Hospitalisation de Semaine, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Patrick Escarmant
- Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Vincent Vinh-Hung
- UF 1401 Radiothérapie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - Stefanos Bougas
- UF 1401 Radiothérapie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - André Cabie
- PCCEI, Université de Montpellier, INSERM, EFS, Université Antilles, Montpellier, France
- Service des maladies infectieuses et tropicales, Martinique, CHU de Martinique, Fort-de-France, Martinique, France
- CIC-1424, INSERM, CHU de Martinique, Fort-de-France, Martinique, France
| | - Clarisse Joachim
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
- PCCEI, Université de Montpellier, INSERM, EFS, Université Antilles, Montpellier, France
| |
Collapse
|
2
|
Marques AD, Moura AR, Hora EC, Brito ÉDAC, Oliviera LS, Feitosa IR, Freitas FF, Lima MS, de Carvalho Barreto ÍD, Santos MO, da Silva AM, Lima CA. Analysis of breast cancer survival in a northeastern Brazilian state based on prognostic factors: A retrospective cohort study. PLoS One 2022; 17:e0263222. [PMID: 35113931 PMCID: PMC8812889 DOI: 10.1371/journal.pone.0263222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/16/2022] [Indexed: 11/19/2022] Open
Abstract
Breast cancer is a major health problem worldwide. Analysis of breast cancer epidemiology in emerging countries enables assessment of prognostic factors, cancer care quality, and the equity of resource distribution. We aimed to estimate the overall (OS) and cancer-specific survival (SS) of breast cancer patients in the northeastern Brazilian state of Sergipe to identify independent prognostic factors. We analyzed a cohort for the factors age at diagnosis, place of residence, time to treatment, staging, and molecular classification, using the Kaplan–Meier method, log-rank test, Pearson’s chi-squared test and Cox regression model. The outcome was the vital status at the end of the study. Our analysis showed an OS probability of 0.72 and an SS probability of 0.75. In multivariate analysis, time to treatment within 60 days, stage IV, and triple-negative classification remained independent prognostic factors for both OS [unadjusted hazard ratio (HRp) 1.50 (1.21; 1.86), HRp 16.56 (8.35; 32.85), and HRp 2.73 (1.73; 4.29), respectively] and SS [HRp 1.43 (1.13; 1.81), HRp 20.53 (9.45; 44.56), and HRp 3.14 (1.88; 5.26), respectively]. Better survival was demonstrated for the following patients: those receiving their first treatment after 60 days, with an OS of 52.5 months (51.2; 53.8) and SS of 53.5 months (52.3; 54.7); stage I patients, with an OS of 58.8 months (57.7; 60.0) and SS of 59.2 months (58.1; 60.3); patients without nodal metastasis, with an OS of 54.2 months (53.0; 55.4) and SS of 55.6 months (54.5; 56.7); and patients with luminal A classification, with an OS of 56.8 months (55.0; 58.5) and SS of 57.8 months (56.2; 59.4). This study identified independent prognostic factors and that OS and SS were lower for patients from Sergipe than for patients in high-income areas. Therefore, determining the profiles of breast cancer patients in this population will inform specific cancer care.
Collapse
MESH Headings
- Aged
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
Collapse
Affiliation(s)
- Adriane Dórea Marques
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Alex Rodrigues Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
| | - Evânia Curvelo Hora
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
| | - Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
| | | | | | | | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
| | | | | | - Angela Maria da Silva
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
| | - Carlos Anselmo Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital-Federal University of Sergipe/EBSERH, Aracaju, Sergipe, Brazil
- Hospital-based Cancer Registry/HUSE/SES, Aracaju, Sergipe, Brazil
| |
Collapse
|
3
|
Maajani K, Jalali A, Alipour S, Khodadost M, Tohidinik HR, Yazdani K. The Global and Regional Survival Rate of Women With Breast Cancer: A Systematic Review and Meta-analysis. Clin Breast Cancer 2019; 19:165-177. [PMID: 30952546 DOI: 10.1016/j.clbc.2019.01.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most common cancer among women in the world. The aim of this study was to measure the global and regional survival rates of women with breast cancer. We searched Medline/PubMed, Web of Science, Scopus, and Google Scholar to identify cohort studies on the survival rate of women with primary invasive breast cancer until the end of June 2017. We used random effect models to estimate the pooled 1-, 3-, 5-, and 10-year survival rates. Subgroup analysis and meta-regression models were used to investigate the potential sources of heterogeneity. One hundred twenty-six studies were included in the meta-analysis. Between-study heterogeneities in the 1-, 3-, 5-, and 10-year survival rates were significantly high (all I2s > 50%; P = .001). The global 1-, 3-, 5-, and 10-year pooled survival rates in women with breast cancer were 0.92 (95% confidence interval [CI], 0.90-0.94), 0.75 (95% CI, 0.71-0.79), 0.73 (95% CI, 0.71-0.75), and 0.61% (95% CI, 0.54-0.67), respectively. Subgroup analysis revealed that survival rates varied in different World Health Organization regions, age and stage at diagnosis, year of the studies, and degree of development of countries. Meta-regression indicated that year of the study (β = 0.07; P = .002) and development of country (β = -0.1; P = .0001) were potential sources of heterogeneity. The survival rate was improved in recent decades; however, it is lower in developing regions than developed ones.
Collapse
Affiliation(s)
- Khadije Maajani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Alipour
- Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Gerash University of Medical Sciences, Gerash, Iran
| | - Hamid Reza Tohidinik
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
4
|
Azubuike SO, Muirhead C, Hayes L, McNally R. Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review. World J Surg Oncol 2018; 16:63. [PMID: 29566711 PMCID: PMC5863808 DOI: 10.1186/s12957-018-1345-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 02/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite mortality from breast cancer in Africa being higher than in high income countries, breast cancer has not been extensively studied in the region. The aim of this paper was to highlight the rising burden of breast cancer with an emphasis on sub-Saharan Africa as well as trends, characteristics, controversies and their implications for regional development. METHODOLOGY A review of published studies and documents was conducted in Medline, Scopus, Pubmed and Google using combinations of key words-breast neoplasm, breast cancer, cancer, incidence, mortality, Africa, Nigeria. Graphical and frequency analyses were carried out on some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website. FINDINGS Globally, about 25% and 15% of all new cancer cases and cancer deaths respectively among females were due to breast cancer. Africa currently had the highest age-standardized breast cancer mortality rate globally, with the highest incidence rates being recorded within the sub-Saharan African sub-region. Incidence trends such as inherently aggressive tumour and younger age profile had been subject to controversies. Certain factors such as westernized diet, urbanization and possibly increasing awareness had been implicated, though their specific contributions were yet to be fully established. CONCLUSION Unless urgent action is taken, breast cancer will compound sub-Saharan Africa's disease burden, increase poverty and gender inequality as well as reverse the current global gains against maternal and neonatal mortality.
Collapse
Affiliation(s)
- Samuel O. Azubuike
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Department of Public and Environmental Health, National Open University of Nigeria, Plot 91, Cadastral Zone, Nnamdi Azikiwe Express Way, Jabi, Abuja, Nigeria
| | - Colin Muirhead
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Richard McNally
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| |
Collapse
|
5
|
[Presentation and outcome of breast cancer under 40 years - A French monocentric study]. ACTA ACUST UNITED AC 2018; 46:105-111. [PMID: 29361410 DOI: 10.1016/j.gofs.2017.12.012] [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: 07/30/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the impact of young age on breast cancer presentation and women's prognosis. METHODS We performed a descriptive retrospective study in the university teaching hospital of Tours from January 2007 to December 2013. All women managed for an invasive breast cancer were included. The population was divided in 2 groups according to age: ≤40 years and>40 years. We studied differences in histological, management and outcome characteristics. RESULTS Two thousand and eighty three women with an invasive breast cancer were included. A hundred and fifty five in the group of women with an age ≤40 years and 1928 in the group of women with an age>40 years. Histological characteristics of breast cancer in younger women were worse than in their older counterparts (with more aggressive features: grade 3, negative hormone receptors, positive Her 2 status, triple negative molecular sub-type). Overall survival was lower in young women than in women age>40 years (P=0.05),as was recurrence free survival (P<0.001), locoregional recurrence free survival (P=0.02) and distant metastasis free survival(P<0.001). Age≤40 years was an independent factor predictive of poor recurrence free survival. CONCLUSION In our study we found an impact of age≤40 years on invasive breast cancer presentation and prognosis.
Collapse
|
6
|
Yan X, Han R, Zhou J, Yu H, Yang J, Wu M. Incidence, mortality and survival of female breast cancer during 2003-2011 in Jiangsu province, China. Chin J Cancer Res 2016; 28:321-9. [PMID: 27478317 PMCID: PMC4949277 DOI: 10.21147/j.issn.1000-9604.2016.03.06] [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] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the incidence, mortality and survival status of female breast cancer in Jiangsu province of China. METHODS Population-based cancer registry data in Jiangsu province were collected during 2003-2011. Crude rates, age-specific rates, age-standardized rates and annual percent changes of incidence and mortality were calculated to describe the epidemiologic characteristics and time trends. Patients diagnosed from 2003 to 2005 were chosen for analyzing the survival status of breast cancer. RESULTS From 2003 to 2011, 17,605 females were diagnosed with breast cancer and 4,883 died in selected registry areas in Jiangsu province. The crude incidence rate was 25.18/100,000, and the age-standardized rates by Chinese population (ASRC) and by world population (ASRW) were 19.03/100,000 and 17.92/100,000, respectively. During the same period, the crude mortality rate was 6.98/100,000 and the ASRC and ASRW were 4.93/100,000 and 4.80/100,000, respectively. From 2003 to 2011, the incidence and mortality increased with annual percent change of 11.37% and 5.78%, respectively. For survival analysis, 1,392 patients in 7 areas were identified in 2003-2005 and finished 5 years of follow-up. Survival rates were found to decrease with survival years, the 5-year observed survival rate was 45.9% and the relative survival rate was 52.0%. We also found that the survival rate varied across the province, which was lower in the north and higher in the south of Jiangsu province. CONCLUSIONS Breast cancer has become a significant public health problem in Jiangsu province and China. More resources should be invested in primary prevention, earlier diagnosis and better health services in order to increase survival rates among Chinese females.
Collapse
Affiliation(s)
- Xinran Yan
- Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Renqiang Han
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jinyi Zhou
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Hao Yu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jie Yang
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Ming Wu
- Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing 210009, China; Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| |
Collapse
|
7
|
Bertaut A, Mounier M, Desmoulins I, Guiu S, Beltjens F, Darut-Jouve A, Ponnelle T, Arnould L, Arveux P. Stage IV breast cancer: a population-based study about prognostic factors according to HER2 and HR status. Eur J Cancer Care (Engl) 2015; 24:920-8. [PMID: 25757548 DOI: 10.1111/ecc.12306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2015] [Indexed: 11/29/2022]
Abstract
We aim to describe trends in net survival (NS) and to assess the prognostic factors among women with de novo metastatic breast cancer (MBC) according to human epidermal growth factor receptor 2 (HER2) and hormone receptor (HR) status. Data on women suffering from de novo MBC and diagnosed from 1998 to 2009 were provided by the Côte-d'Or breast cancer registry. NS was described using the Pohar Perme estimator and prognostic factors were investigated in a generalised linear model. We identified 232 patients (mean age = 64.7). Median NS was 29.2 months, 1- and 5-year NS were 76% and 26% respectively. The survival trend in patients with HER2-positive tumours who did not receive trastuzumab was similar to that in women with triple-negative tumours. A higher relative excess risk of death by cancer was observed for high-grade tumours [RER, relative excess rates = 1.76 (95% CI, confidence intervals: 1.17-2.62) for Scarff Bloom Richardson grade 3 vs. 1 + 2], while a lower risk was observed for luminal tumours [RER = 0.49 (95% CI: 0.27-0.89)] and HER2-positive tumours treated with trastuzumab [RER = 0.28 (95% CI: 0.14-0.59)], both compared with triple-negative tumours. Surgery of the primary tumour was associated with better survival [RER = 0.43 (95% CI: 0.28-0.68)]. With half of the women dead before 29 months, stage IV breast cancer still has a bleak outlook. Progress should continue with new target therapies for both HR and HER2 receptors.
Collapse
Affiliation(s)
- A Bertaut
- Côte d'Or Breast Cancer Registry, CGFL, Dijon, France.,EA 4184 Centre d'Epidémiologie des populations, University of Burgundy, Dijon, France
| | - M Mounier
- Faculty of Medicine, Hemopathies Registry, Dijon, France
| | - I Desmoulins
- Department of Medical Oncology, CGFL, Dijon, France
| | - S Guiu
- Department of Medical Oncology, CGFL, Dijon, France
| | - F Beltjens
- Department of Pathology, CGFL, Dijon, France
| | | | | | - L Arnould
- Department of Pathology, CGFL, Dijon, France
| | - P Arveux
- Côte d'Or Breast Cancer Registry, CGFL, Dijon, France.,EA 4184 Centre d'Epidémiologie des populations, University of Burgundy, Dijon, France
| |
Collapse
|
8
|
Dialla PO, Quipourt V, Gentil J, Marilier S, Poillot ML, Roignot P, Altwegg T, Darut-Jouve A, Guiu S, Arveux P, Dabakuyo-Yonli TS. In breast cancer, are treatments and survival the same whatever a patient's age? A population-based study over the period 1998-2009. Geriatr Gerontol Int 2014; 15:617-26. [DOI: 10.1111/ggi.12327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Pegdwende Olivia Dialla
- Breast and Gynaecologic Cancer Registry of Côte d'Or; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
- EA 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | - Valérie Quipourt
- Coordination Unit in Geriatric Oncology in Burgundy; Hôpital de jour Gériatrique; Hôpital de Champmaillot; Dijon Cedex France
| | - Julie Gentil
- Breast and Gynaecologic Cancer Registry of Côte d'Or; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
- EA 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | - Sophie Marilier
- Coordination Unit in Geriatric Oncology in Burgundy; Hôpital de jour Gériatrique; Hôpital de Champmaillot; Dijon Cedex France
| | - Marie-Laure Poillot
- Breast and Gynaecologic Cancer Registry of Côte d'Or; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
- EA 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | | | | | | | - Sévérine Guiu
- Department of Medical Oncology; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Côte d'Or; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
- EA 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | - Tienhan Sandrine Dabakuyo-Yonli
- EA 4184; Faculty of Medicine; University of Burgundy; Dijon France
- Biostatistics and Quality of Life Unit; Centre Georges François Leclerc Comprehensive Cancer Centre; Dijon Cedex France
| |
Collapse
|
9
|
Morgan JL, Reed MW, Wyld L. Primary endocrine therapy as a treatment for older women with operable breast cancer - a comparison of randomised controlled trial and cohort study findings. Eur J Surg Oncol 2014; 40:676-84. [PMID: 24703110 DOI: 10.1016/j.ejso.2014.02.224] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection. METHODS A systematic review of the literature was performed to try and establish if this form of treatment is still valid in modern breast practice. RESULTS Six randomised controlled trials (RCTs) and 31 non-randomised studies were deemed eligible. Available data demonstrate an advantage for surgery over PET in terms of disease control and a likely survival benefit in patients with a predicted life expectancy of five years or more. Patients treated only with aromatase inhibitors (AIs) had superior rates of disease control when compared to Tamoxifen. CONCLUSIONS Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.
Collapse
Affiliation(s)
- J L Morgan
- Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK.
| | - M W Reed
- Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK.
| | - L Wyld
- Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK.
| |
Collapse
|
10
|
Seror V, Cortaredona S, Bouhnik AD, Meresse M, Cluze C, Viens P, Rey D, Peretti-Watel P. Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery. Psychooncology 2013; 22:2546-56. [PMID: 23749441 DOI: 10.1002/pon.3316] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). METHODS A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. RESULTS The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. CONCLUSIONS Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.
Collapse
Affiliation(s)
- Valérie Seror
- INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Dialla PO, Dabakuyo TS, Marilier S, Gentil J, Roignot P, Darut-Jouve A, Poillot ML, Quipourt V, Arveux P. Population-based study of breast cancer in older women: prognostic factors of relative survival and predictors of treatment. BMC Cancer 2012; 12:472. [PMID: 23066863 PMCID: PMC3517437 DOI: 10.1186/1471-2407-12-472] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/09/2012] [Indexed: 02/04/2023] Open
Abstract
Background A large proportion of women with breast cancer (BC) are elderly. However, there is a lack of information regarding BC prognostic factors and care in this population. The aims of this study were to assess the prognostic factors of relative survival (RS) among women with BC aged ≥ 75 years old and to identify the predictive factors of treatments administered to this population. Methods A population-based study was performed using data from the Cote d’Or breast and gynaecological cancer registry. Women aged 75 years and older with primary invasive BC and resident in Cote d’Or at the time of diagnosis made between January 1998 and December 2008 were retrospectively selected. Prognostic factors of RS were estimated in a generalized linear model with a Poisson error structure. RS rate for the whole population was given at 5 years. Logistic regression models were used to identify the predictors of the treatments administered. Results Six hundred and eighty-one women were included. Median age at diagnosis was 80. Comorbidities (p=0.02), pT stage (p=0.04), metastases (p=<0.001), having a family doctor (p=0.03) and hormone-receptor status (p=0.006) were independent prognostic factors of RS. The RS rate at 5 years for the whole population was 78.2%, 95%CI = [72.2-83.0]. Age, pT stage, metastases, histoprognostic SBR grade, hormone receptor status and comorbidities were frequently found to be predictors of treatment with surgery alone, hormone therapy alone, breast conserving surgery plus adjuvant therapy and mastectomy plus adjuvant therapy. Conclusions Comorbid conditions adversely affect survival in older women with breast cancer. Moreover the results of this study showed that there are numerous predictors of the type of treatment administered, and that the most important were age and comorbidities.
Collapse
Affiliation(s)
- Pegdwende Olivia Dialla
- Breast and Gynaecologic Cancer Registry of Cote d'Or, Centre Georges François Leclerc, 1 rue Professeur Marion BP 77980, Dijon Cedex 21079, France
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Grafféo N, Jooste V, Giorgi R. The impact of additional life-table variables on excess mortality estimates. Stat Med 2012; 31:4219-30. [DOI: 10.1002/sim.5493] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/25/2012] [Indexed: 02/04/2023]
Affiliation(s)
- Nathalie Grafféo
- Aix-Marseille Univ, UMR 912, SESSTIM; F-13284 Marseille France
- Inserm; UMR 912, SESSTIM; F-13284 Marseille France
- IRD; UMR 912, SESSTIM; F-13284 Marseille France
| | - Valérie Jooste
- Registre Bourguignon des Cancers Digestifs; Inserm U866, “Lipides, Nutrition, Cancer”, CHU Dijon; 21079 Dijon France
| | - Roch Giorgi
- Aix-Marseille Univ, UMR 912, SESSTIM; F-13284 Marseille France
- Inserm; UMR 912, SESSTIM; F-13284 Marseille France
- IRD; UMR 912, SESSTIM; F-13284 Marseille France
- APHM; hôpital Timone, Service de Santé Publique et d'Information Médicale; F-13005 Marseille France
| |
Collapse
|
13
|
DABAKUYO T, DIALLA O, GENTIL J, POILLOT ML, ROIGNOT P, CUISENIER J, ARVEUX P. Breast cancer in men in Cote d'Or (France): epidemiological characteristics, treatments and prognostic factors. Eur J Cancer Care (Engl) 2012; 21:809-16. [DOI: 10.1111/j.1365-2354.2012.01365.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
14
|
Epidemiology of breast cancer in europe and Africa. J Cancer Epidemiol 2012; 2012:915610. [PMID: 22693503 PMCID: PMC3368191 DOI: 10.1155/2012/915610] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/19/2012] [Accepted: 03/11/2012] [Indexed: 11/17/2022] Open
Abstract
Breast cancer continues to remain the most lethal malignancy in women across the world. This study reviews some of the epidemiological similarities and differences in breast cancer between white European women and black African women with the aim of optimising care for women with breast malignancy across the world. The incidence of breast cancer is lower among African women than their European counterparts. Majority of women in Europe are postmenopausal when they present with breast cancer; however, the peak incidence among African women is in the premenopausal period. Ductal carcinoma is the commonest type of breast cancer among women in Africa and Europe. However, medullary and mucinous carcinomas are more common in Africa than in Europe. While European women usually present at an early stage especially with the advent of screening, African women generally present late for treatment resulting in lower survival rates. There should be more research at the molecular level among African women to identify genetic factors that may contribute to the risk of developing breast cancer. There should also be improvement in the health care system in Africa in order to optimise care for women with breast cancer.
Collapse
|
15
|
Ali AMG, Greenberg D, Wishart GC, Pharoah P. Patient and tumour characteristics, management, and age-specific survival in women with breast cancer in the East of England. Br J Cancer 2011; 104:564-70. [PMID: 21326244 PMCID: PMC3049594 DOI: 10.1038/bjc.2011.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Breast cancer relative survival (BCRS), which compares the observed survival of women with breast cancer with the expected survival of women for the whole population of the same age, time period, and geographical region, tends to be poorer in older women, but the reasons for this are not clear. We examined the influence of patient and tumour characteristics, and treatment on BCRS to see whether these could explain the age-specific effect. METHODS Data for 14,048 female breast cancer patients diagnosed from 1999 to 2007, aged 50 years or over were obtained from the Eastern Cancer Registration and Information Centre. We estimated relative 5- and 10-year survival for patients in four age groups (50-69, 70-74, 75-79, and 80+ years). We also modelled relative excess mortality (REM) rate using Poisson regression adjusting for patient characteristics and treatment. The REMs derived from these models quantify the extent to which the hazard of death differs from the hazard in the reference category, after taking into account the background risk of death in the general population. We compared the results with those obtained for breast cancer-specific mortality, analysed using multivariate Cox regression. RESULTS Median follow-up time was 4.7 years. Relative 5-year survival was 89, 81, 76, and 70% for patients aged 50-69, 70-74, 75-79, and 80+ years, respectively. Corresponding relative 10-year survival was 84, 77, 67, and 66%. Unadjusted REM was 1.93, 2.74, and 3.88 for patients aged 70-74, 75-79, and 80+ years, respectively, (50-69 years as reference). The equivalent hazard ratios from the Cox model were 1.88, 2.45, and 3.81. These were attenuated after adjusting for confounders (REM - 1.49, 1.36, and 1.23; Cox - 1.47, 1.50, and 1.76). CONCLUSION We confirmed poorer BCRS in older women in our region. This was partially explained by known prognostic factors. Further research is needed to determine whether biological differences or suboptimal management can explain the residual excess mortality.
Collapse
Affiliation(s)
- A M G Ali
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK,E-mail:
| | - D Greenberg
- Eastern Cancer Registration and Information Centre, Cambridge, UK
| | - G C Wishart
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK,Department of Oncology, University of Cambridge, Cambridge, UK
| |
Collapse
|
16
|
Janssen-Heijnen ML, Gondos A, Bray F, Hakulinen T, Brewster DH, Brenner H, Coebergh JWW. Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers. J Clin Oncol 2010; 28:2520-8. [DOI: 10.1200/jco.2009.25.9697] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose When cancer survivors wish to receive accurate information on their current prognosis during follow-up, conditional 5-year relative survival may be most suitable. We have estimated conditional 5-year relative survival for 13 cancers using a large European database—European Network for Indicators on Cancer (EUNICE)—of 10 dedicated long-standing cancer registries across Europe. Patients and Methods Patients age 15 years and older diagnosed between 1985 and 2004 were included. Conditional 5-year relative survival for each age group was computed for every additional year survived up to 10 years. Period analysis with follow-up period 2000 to 2004 was used. Results All patients with cutaneous melanoma or colorectal, endometrial, or testis cancer and younger patients with stomach, glottis, cervix, ovary, or thyroid cancer or non-Hodgkin's lymphoma exhibited hardly any excess mortality (conditional 5-year relative survival > 95%) given that they were alive at a defined time point within 10 years of initial diagnosis. However, patients with supraglottis, lung, breast, and kidney cancer, as well as older patients with most cancers exhibited substantial excess mortality (conditional 5-year relative survival < 90%). Initial differences in relative survival at diagnosis between age groups largely disappeared with time since initial diagnosis for melanoma, or stomach, colorectal, corpus uteri, or testicular cancer but persisted for patients diagnosed with other tumors. Differences between stage groups became smaller over time or disappeared. Conclusion Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.
Collapse
Affiliation(s)
- Maryska L.G. Janssen-Heijnen
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Adam Gondos
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Freddie Bray
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Timo Hakulinen
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - David H. Brewster
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Hermann Brenner
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Jan-Willem W. Coebergh
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| |
Collapse
|
17
|
López-Olmos J. Cáncer de mama en una mujer de 25 años. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2010. [DOI: 10.1016/j.gine.2008.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Guerra MR, Mendonça GAES, Bustamante-Teixeira MT, Cintra JRD, Carvalho LMD, Magalhães LMPVD. Sobrevida de cinco anos e fatores prognósticos em coorte de pacientes com câncer de mama assistidas em Juiz de Fora, Minas Gerais, Brasil. CAD SAUDE PUBLICA 2009; 25:2455-66. [DOI: 10.1590/s0102-311x2009001100015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 07/10/2009] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi analisar a sobrevida de cinco anos e os fatores prognósticos em mulheres com câncer invasivo da mama, submetidas à cirurgia e assistidas em Juiz de Fora, Minas Gerais, Brasil, com diagnóstico da doença entre 1998 e 2000. As variáveis analisadas foram: idade, cor, local de residência, variáveis relacionadas ao tumor e ao tratamento. Foram estimadas as funções de sobrevida pelo método de Kaplan-Meier, e o modelo de riscos proporcionais de Cox foi utilizado para avaliação prognóstica. A sobrevida estimada foi de 81,8%. Tamanho tumoral e comprometimento de linfonodos axilares foram os fatores prognósticos independentes mais importantes, com risco de óbito aumentado para mulheres com tamanho do tumor maior que 2,0cm (HR = 1,97; IC95%: 1,26-3,07) e com metástase para gânglios axilares (HR = 4,04; IC95%: 2,55-6,39). Tais achados enfatizam a importância do diagnóstico e tratamento precoces. O acesso às ações de rastreamento nos diversos níveis de assistência, especialmente para o grupo considerado como de maior risco, deve ser uma prioridade para os gestores de saúde no país.
Collapse
|
19
|
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
|
20
|
Sentinel lymph node biopsy in two Burgundy districts: prospective multicentric study on 528 breast cancers during the year 2005. Arch Gynecol Obstet 2009; 281:491-8. [PMID: 19554339 DOI: 10.1007/s00404-009-1163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our purpose was to assess development of sentinel lymph node biopsy (SLNB) in two Burgundy districts during the year 2005. METHODS All women undergoing breast surgery as primary care between 1 January 2005 and 1 January 2006 were eligible for inclusion. Eleven surgeons from five different breast-treatment centres took part in this prospective multicentric study. As our objective was to evaluate practices, patients were not randomized and surgeons were free to choose treatment patterns. RESULTS The 528 enrolled cases account for 90% of all new breast cancers in 2005 in Cote d'Or and Saône et Loire. Half of these patients (286) fulfilled requirements for SLNB. The others (242) had primary full axillary clearance (AC). Four of our five centres offer double-detection of sentinel lymph nodes as well as intraoperative pathology examination. Most tumours were invasive ductal carcinomas, with an average size of 12 mm in the SLNB group (T1C) and 22 mm in the AC group (T2). Two or three lymph nodes were removed during each SLNB procedure. Whereas most SLNB studies report around 25% positive nodes, we barely recorded 18.5% (53 of our 256 patients). Moreover, 2/3 of these node-positive patients had optimal care since additional axillary clearance was done right away. CONCLUSION Sentinel lymph node biopsy has become routine practice in our Burgundy area. It is mainly dedicated to early stage breast cancer with limited metastatic risk. Our surgeons follow the most recent guidelines and indications are the same regardless of treatment centre.
Collapse
|
21
|
Analysis of the effect of age on the prognosis of breast cancer. Breast Cancer Res Treat 2008; 117:121-9. [DOI: 10.1007/s10549-008-0222-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 10/02/2008] [Indexed: 11/26/2022]
|
22
|
Molinié F, Billon-Delacour S, Allioux C, Blais S, Bercelli P, Lombrail P. Incidence et facteurs pronostiques des cancers du sein découverts au cours et en dehors du programme de dépistage organisé en Loire-Atlantique (1991–2002). Rev Epidemiol Sante Publique 2008; 56:41-9. [DOI: 10.1016/j.respe.2008.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/26/2007] [Accepted: 01/07/2008] [Indexed: 11/28/2022] Open
|
23
|
Grosclaude P. [Contributions of the descriptive epidemiology, the registers and the troops. French situation seen by the registers of population]. Med Sci (Paris) 2007; 23 Spec No 3:22-5. [PMID: 17939922 DOI: 10.1051/medsci/2007233s22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article describes the situation of the cancer at the elderly in France from a synthesis of various studies carried out by the French network of the registers of cancer, only source of information which is not soiled on the bias by selection. The cancer is especially a pathology of the old subject, 47 % of the cases of cancers arise at people's of more 70 years, 30 % beyond 75 years and 14 % at the people of more than 80 years. This proportion is 42 % at the women of more 70 years, 30 % beyond 75 years and 17 % at the women of more than 80 years. The forecast of these patients degrades with the age. The bad forecast of the old subjects is often associated, and sometimes totally owed, with a strong initial mortality which can be connected either to the initial gravity of the disease, or in the coverage which is less aggressive at the same moment for the old subjects and more selective. double dagger.
Collapse
Affiliation(s)
- Pascale Grosclaude
- Secrétaire du réseau Francim, Chargée de mission Evaluation au Département qualité des soins et Innovation, Institut national du cancer, Registre des cancers du Tarn, BP 37, 81001 Albi Cedex, France.
| |
Collapse
|
24
|
Étude ELIPPSE 65-80. Med Sci (Paris) 2007; 23 Spec No 3:52-4. [DOI: 10.1051/medsci/2007233s52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Survie des patients atteints de cancer en France: principaux résultats de la première étude du réseau des registres français des cancers (Francim). ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0721-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
26
|
Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 2007; 25:1858-69. [PMID: 17488984 DOI: 10.1200/jco.2006.10.4208] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite increased interest in treatment of senior cancer patients, older patients are much too often undertreated. This review aims to present data on treatment practices of older women with breast and gynecologic cancers and on the consequences of undertreatment on patient outcome. We also discuss the reasons and validity of suboptimal care in older patients. Numerous studies have reported suboptimal treatment in older breast and gynecologic cancer patients. Undertreatment displays multiple aspects: from lowered doses of adjuvant chemotherapy to total therapeutic abstention. Undertreatment also concerns palliative care, treatment of pain, and reconstruction. Only few studies have evaluated the consequences of nonstandard approaches on cancer-specific mortality, taking into account other prognostic factors and comorbidities. These studies clearly showed that undertreatment increased disease-specific mortality for breast and ovarian cancers. For other gynecological cancers, data were insufficient to draw conclusions. Objective reasons at the origin of undertreatment were, notably, higher prevalence of comorbidity, lowered life expectancy, absence of data on treatment efficacy in clinical trials, and increased adverse effects of treatment. More subjective reasons were putative lowered benefits of treatment, less aggressive cancers, social marginalization, and physician's beliefs. Undertreatment in older cancer patients is a well-documented phenomenon responsible for preventable cancer deaths. Treatments are still influenced by unclear standards and have to be adapted to the older patient's general health status, but should also offer the best chance of cure.
Collapse
Affiliation(s)
- Christine Bouchardy
- Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University, Geneva, Switzerland.
| | | | | | | | | |
Collapse
|
27
|
Gueth U, Wight E, Schoetzau A, Langer I, Dieterich H, Rochlitz C, Herberich L, Holzgreve W, Singer G. Non-inflammatory skin involvement in breast cancer, histologically proven but without the clinical and histological T4 category features. J Surg Oncol 2007; 95:291-7. [PMID: 17326124 DOI: 10.1002/jso.20660] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The study evaluates characteristics and prognostic significance of breast cancer with histologically proven non-inflammatory skin involvement but without the clinical and histological features that are mandatory for inclusion in the T4 category. METHODS We compared retrospectively the clinical course of 55 patients with this clinico-pathologic entity to the outcome of a control group of 309 consecutive patients with tumors of the same size but without skin involvement. The median follow-up time was 6.6 years in the study and 8.4 years in the control group. Two subsets were analyzed: (A) 1.1-2.0 cm (T1c); (B) 2.1-5.0 cm (T2). RESULTS The distribution of TNM stages within Study Group A was: Stage I: 28.6%, Stage II: 61.9%, Stage III: 9.5%. The distribution within Study Group B was: Stage II: 67.7%, Stage III: 23.5%, and Stage IV: 8.8%. Differences in disease-specific survival (DSS) between study and control groups were not significant. In multivariate analysis, skin involvement was not a significant variable, while lymph node involvement was found to be significant for worse outcome (Group A: HR=3.99 [1.33-12.05], P=0.014; Group B: HR=2.37 [1.37-4.08], P=0.002). CONCLUSION Breast carcinomas with histologically proven skin involvement without the clinical and histological correlate are a heterogeneous group of cases, but the majority of the patients have Stage I/II disease. While lymph node involvement had a most significant effect on DSS, skin involvement was not a significant prognostic factor. Physicians must be aware of this clinico-pathologic entity in order not to misclassify these cases as T4 and consider them falsely as being locally advanced breast cancer.
Collapse
Affiliation(s)
- Uwe Gueth
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse, Basel, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Mallol N, Desandes E, Lesur-Schwander A, Guillemin F. Disease-specific and event-free survival in breast cancer patients: a hospital-based study between 1990 and 2001. Rev Epidemiol Sante Publique 2006; 54:313-25. [PMID: 17088696 DOI: 10.1016/s0398-7620(06)76727-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In France, as in other countries, breast cancer care has changed due to therapeutic advances and organized screening programs. Can the effect of new therapeutic procedures over time be measured by health care institutions considering these changes? The present study used data from a hospital-based cancer registry to analyze changes in 5-year disease-specific and event-free survival among women with primary breast cancer over three time periods (1990-1993, 1994-1997, and 1998-2001). METHODS All cases of primary invasive breast carcinomas, initially treated in a French Comprehensive Cancer Center between 1990 and 2001, were included. In situ breast carcinoma and male breast cancer were excluded. Cox proportional hazards models were used to analyze disease-specific and event-free survival (DSS and EFS) rates over the three time periods (1990-1993, 1994-1997, and 1998-2001). RESULTS During the 1990-2001 period, 4,165 primary breast cancers were initially treated at the Comprehensive Cancer Center. Out of 1,012 deaths overall, 74.6% were due specifically to primary breast cancer (respectively 98% from cancer itself and 2% from treatment side effects); the cause was unknown for only 3.3% of deaths. Out of 3,810 complete remissions, 18.2% presented local, regional or metastatic relapse and 3.8% presented a second primary breast cancer. Comparison of DSS and EFS rates in a recent reporting period (1998-2001) with those in earlier time periods (1994-1997 and 1990-1993) indicated that substantial survival gains were achieved with respectively 88.4% (95% CI: 86.4-90.5), 83.2% (95% CI: 81.3-85.2), and 79.8% (95% CI: 77.4-82.2) (p<0.01) for 5-year Disease-Specific Survival, and respectively 78.3% (95% CI: 75.7-81.0), 73.9% (95% CI: 71.6-76.3), and 70.1% (95% CI: 67.4-72.8) (p<0.01) for 5-year Event-Free Survival. After adjustment for prognostic factors, period was identified as an independent predictor of survival. CONCLUSION Survival improvement is likely to be due to changes in routine clinical practice such as an increased use of systemic adjuvant therapy over the study periods, dose modification of epirubicin in adjuvant chemotherapy for node-positive breast cancer since 1994, and organized screening programs since 1997. However the effect of possible early diagnosis and over-diagnosis biases due to screening cannot be assessed.
Collapse
Affiliation(s)
- N Mallol
- Centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy Cedex
| | | | | | | |
Collapse
|
29
|
Bossard N, Velten M, Remontet L, Belot A, Maarouf N, Bouvier AM, Guizard AV, Tretarre B, Launoy G, Colonna M, Danzon A, Molinie F, Troussard X, Bourdon-Raverdy N, Carli PM, Jaffré A, Bessaguet C, Sauleau E, Schvartz C, Arveux P, Maynadié M, Grosclaude P, Estève J, Faivre J. Survival of cancer patients in France: a population-based study from The Association of the French Cancer Registries (FRANCIM). Eur J Cancer 2006; 43:149-60. [PMID: 17084622 DOI: 10.1016/j.ejca.2006.07.021] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 07/26/2006] [Accepted: 07/27/2006] [Indexed: 10/23/2022]
Abstract
We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.
Collapse
Affiliation(s)
- N Bossard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Ibrahim EM, Ezzat AA, Rahal MM, Raja MM, Ajarim DS. Adjuvant chemotherapy in 780 patients with early breast cancer: 10-year data from Saudi Arabia. Med Oncol 2006; 22:343-52. [PMID: 16260851 DOI: 10.1385/mo:22:4:343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Accepted: 09/09/2003] [Indexed: 11/11/2022]
Abstract
BACKGROUND By and large, data about adjuvant chemotherapy for breast cancer in the Middle East are lacking. Retrospective analysis of prospectively captured data from a main referral center in the Kingdom of Saudi Arabia (KSA) may shed some light on the clinicopathological features and survival of patients offered adjuvant chemotherapy in a similar population in that part of the world. PATIENTS AND METHODS Data on patients with invasive breast cancer (Stages I to IIIA) seen between 1992 and the end of 2001 and who received adjuvant chemotherapy were analyzed. A total of 780 patients were considered eligible and constitute the basis of this report. RESULTS The median age +/- SD of the 780 patients was 42 +/- 9.6 yr. The majority of patients were younger than 50 yr (78%) and premenopausal (83%). Ten percent, 69%, and 21% of patients had Stage I, II, and IIIA, respectively. Patients expressed relatively high prevalence of adverse clinicopathological characteristics. Most patients (523 patients, 67%) received anthracyclines-containing adjuvant chemotherapy, 610 patients (78%) received adjuvant radiotherapy, and 296 (38%) received adjuvant tamoxifen. At a median follow-up of 42 mo (95% CI, 38.1-62.8 mo), the median overall (OS) and disease-free survival (DFS) were not reached; however, the 5-yr actuarial survival was estimated as 74% and 59%, respectively. Cox proportional regression hazard model identified positive axillary nodal status, and positive vascular invasion are the only variables that influenced OS adversely. The model also distinguished the same variables plus negative estrogen receptor status as covariates with negative effect on DFS. CONCLUSION In conclusion, this series of 780 predominantly young patients with breast cancer receiving adjuvant chemotherapy highlighted the disease patterns and survival outcome in the KSA. The current series is significant being one of the few reports about adjuvant chemotherapy experience in a developing country and certainly the first from that part of the world.
Collapse
Affiliation(s)
- Ezzeldin M Ibrahim
- Department of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
| | | | | | | | | |
Collapse
|
31
|
Cutuli B, Cottu PH, Guastalla JP, Mechin H, Costa A, Jourdan R. A French national survey on infiltrating breast cancer: analysis of clinico-pathological features and treatment modalities in 1159 patients. Breast Cancer Res Treat 2005; 95:55-64. [PMID: 16261401 DOI: 10.1007/s10549-005-9034-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the approximate 42,000 yearly new cases of breast cancer in France, there have been very few exhaustive studies on the clinicopathological features and treatment options of this disease. METHODS Thus, a prospective, non-selective, nationwide survey on infiltrating breast cancer (IBC) was conducted in France from September 2001 to April 2002, in order to assess the epidemiological features of newly diagnosed disease, the prognostic and predictive variables with a special emphasis on hormone receptors, and the current approaches to therapy in everyday clinical practice. RESULTS In total, 1159 patients were evaluable (median age 57 years); two-thirds of women were postmenopausal and 38% had undergone hormonal replacement therapy (HRT). Ductal and lobular infiltrating cancers represented 82.3% and 11.6% of cases, respectively. Most tumours expressed oestrogen (79.7%) and progesterone (69.7%) receptors. Overexpression of the human epidermal growth factor receptor-2 oncogene was found in 20.6% of the assessed cases. IBC diagnosed in women under HRT presented significantly better clinico-pathological features than in non-users. All patients underwent surgery as first treatment: 77.5% breast-conserving surgery (BCS) and 22.5% mastectomy; 1024 patients also underwent axillary surgery. The overall axillary lymph-node involvement rate was 44.4%. Radiotherapy was proposed in 98% and 83% of the women who had undergone BCS and mastectomy, respectively. Adjuvant chemotherapy was delivered in 58.7% of patients and hormonal treatment was provided in 76.5% of patients; tamoxifen was the most widely used hormonal treatment. CONCLUSIONS This study showed a trend for global downstaging of IBC (with favourable clinico-pathological features), leading to a high rate of BCS. Postoperative treatments were widely used, in accordance with national and international guidelines. Use of aromatase inhibitors and taxanes was limited, but is likely to rise in the future.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Estrogen Replacement Therapy
- Female
- France/epidemiology
- Health Surveys
- Humans
- Mastectomy
- Menopause
- Middle Aged
- Prognosis
- Prospective Studies
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Survival Rate
Collapse
Affiliation(s)
- Bruno Cutuli
- Department of Oncology and Radiotherapy, Polyclinique de Courlancy, Reims, France.
| | | | | | | | | | | |
Collapse
|
32
|
Vlastos AT, Usel M, Beffa V, Petignat P, Neyroud-Caspar I, Bouchardy C, Vlastos G. Treatments patterns of vulvar cancer in the elderly. Surg Oncol 2004; 13:187-91. [PMID: 15615655 DOI: 10.1016/j.suronc.2004.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate treatment patterns of vulvar cancer in patients over 80 years. MATERIAL AND METHODS Between 1979 and 1999, the Geneva Tumor Registry identified 230 women with vulvar cancer. Treatment of patients over 80 years and younger were compared. Kaplan-Meier analysis was used to determine disease specific cumulative survival. RESULTS Young women are more likely to present in situ lesions compared to their older counterparts. Majority of vulvar cancers were observed in women >or=80 (p<0.001) at more advanced stages. Elderly women have either no treatment, either unconventional or inadequate treatments. The Mantel-Haentzel analysis shows a 23.4 OR (IC (95%) 2.9-186.6) of not being treated if the patient is over 80. Specific 5-years survival was 93% in stage I, compared to 21% in stage IV. CONCLUSION Patients over 80 years are diagnosed at more advanced stages. Less aggressive treatments decrease outcome.
Collapse
Affiliation(s)
- A-T Vlastos
- Department of Obstetrics, Geneva University Hospitals, 30 Boulevard de la Cluse, 1211 Geneva, 14 Switzerland
| | | | | | | | | | | | | |
Collapse
|
33
|
Pierga JY, Girre V, Laurence V, Asselain B, Diéras V, Jouve M, Beuzeboc P, Fourquet A, Nos C, Sigal-Zafrani B, Pouillart P. Characteristics and outcome of 1755 operable breast cancers in women over 70 years of age. Breast 2004; 13:369-75. [PMID: 15454191 DOI: 10.1016/j.breast.2004.04.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Revised: 04/13/2004] [Accepted: 04/15/2004] [Indexed: 11/28/2022] Open
Abstract
From 1981 to 1995, 1755 patients aged 70 years or over who had nonmetastatic unilateral breast carcinoma received curative local or regional treatment in our institute. Median follow-up was 8 years. The median age of these patients was 75 years (range: 70-94), and 86% were under 81 years of age. Tumors were classed as T3-4 in 24% of them; 18% had N1b/N2 tumors, and in 12% grade 3 disease was present. Only 19% were both ER and PR negative. The S phase fraction was <5% in 79% of patients. In 1046 patients (60%) modified radical mastectomy was performed, while 20% underwent lumpectomy and in 20% radiotherapy was the only treatment administered. Adjuvant endocrine therapy was given in 463 (26%) cases, and only 3% of patients received chemotherapy. The median overall survival time was 121 months. The overall cancer-related death rate was 49%. The 10-year disease-free survival (DFS) rate was 64%, and the 10-year local relapse rate was 14%. Prognostic factors determined on univariate analysis were tumor size, clinical nodal status (ER and PR), and grade. No significant difference in outcome was observed between mastectomy and conservative treatment. Parameters for which correlations with DFS were found on multivariate analysis were clinical nodal status (P < 0.0001), tumor size (P < 0.0001), ER (P < 0.0001), and PR (P = 0.04). Breast cancer in elderly women is frequently hormone-dependent (81%) with a low proliferation index. Prognostic factors are the same as in younger postmenopausal patients. More than 50% of these patients died from a cause other than their breast cancer.
Collapse
Affiliation(s)
- J-Y Pierga
- Departement d'Oncologie Medicale, Institut Curie, 26 rue d'Ulm, 75231 Paris Cedex 05, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Cutuli B, Aristei C, Martin C, Perrucci E, Latini P, Quetin P. Breast-conserving therapy for stage I-II breast cancer in elderly women. Int J Radiat Oncol Biol Phys 2004; 60:71-6. [PMID: 15337541 DOI: 10.1016/j.ijrobp.2004.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 02/11/2004] [Accepted: 02/16/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess breast-conserving therapy results in elderly patients with early-stage breast cancer (clinical Stage I-II). METHODS AND MATERIALS Between 1979 and 1998, 196 women (200 treated breasts) aged > or =70 years (median age, 72.5 years) were treated with breast-conserving therapy (lumpectomy or quadrantectomy with axillary lymph node dissection and radiotherapy). Pathologic axillary node involvement was found in 51 patients (28%). Two-thirds of patients received tamoxifen, and 16% received chemotherapy. RESULTS At a median follow-up of 59 months, 3 patients (1.5%) had developed local recurrence and 20 (10.2%) distant metastases. The overall survival rate was 81% and 62% at 5 and 10 years, respectively. The corresponding disease-specific survival rates were 92% and 88%. Axillary nodal involvement was the only statistically significant risk factor for the development of metastases (p = 0.0035). Arm mobility impairment and arm lymphedema each occurred in 5 patients. In another 5 patients, a thromboembolic event occurred during tamoxifen treatment. CONCLUSION Elderly women tolerate breast-conserving therapy, including radiotherapy, well and have excellent rates of locoregional control and disease-specific survival.
Collapse
MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Humans
- Mastectomy, Segmental
- Retrospective Studies
- Survival Rate
Collapse
Affiliation(s)
- Bruno Cutuli
- Department of Radiation Oncology, Polyclinique de Courlancy, 38 rue de Courlancy, Reims 51100, France.
| | | | | | | | | | | |
Collapse
|
35
|
Thulesius H, Håkansson A, Petersson K. Balancing: a basic process in end-of-life cancer care. QUALITATIVE HEALTH RESEARCH 2003; 13:1353-1377. [PMID: 14658351 DOI: 10.1177/1049732303258369] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this grounded theory study, the authors interviewed caregivers and patients in end-of-life cancer care and found Balancing to be a fundamental process explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages were Weighing--sensing needs and wishes signaled by patients, gauging them against caregiver resources in diagnosing and care planning; Shifting--breaking bad news, changing care places, and treatments; and Compensating--controlling symptoms, educating and team-working, prioritizing and "stretching" time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or "Walking a fine line," at best an optimized situation, at worst a deceit.
Collapse
|
36
|
Bouchardy C, Rapiti E, Fioretta G, Laissue P, Neyroud-Caspar I, Schäfer P, Kurtz J, Sappino AP, Vlastos G. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 2003; 21:3580-7. [PMID: 12913099 DOI: 10.1200/jco.2003.02.046] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients. PATIENTS AND METHODS We reviewed clinical files of 407 breast cancer patients aged >/= 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment on mortality by Cox model, accounting for prognostic factors. RESULTS Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery plus adjuvant treatment. CONCLUSION Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient's health status, but also should offer the best chance of cure.
Collapse
Affiliation(s)
- Christine Bouchardy
- Geneva Cancer Registry, 55 Boulevard de la Cluse 55, 1205 Geneva, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ruibal A, Arias JI, Aldecoa B. [Clinical and biological differences between infiltrating ductal carcinomas of the breast in women over 70 years-old and those aged 60-70]. Med Clin (Barc) 2002; 119:761-4. [PMID: 12525308 DOI: 10.1016/s0025-7753(02)73573-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is discrepancy in the literature regarding the behavior of breast cancer in elderly women. For this reason we decided to study the possible clinical and biological differences of infiltrative ductal breast carcinoma between women over 70 years and those aged between 60 and 70 years. PATIENTS AND METHOD The study group included 181 women with infiltrative ductal carcinomas (IDCs) who were referred from a breast clinic (BC) and a breast cancer screening campaign (BCS). 67 of them were older than 70 and 114 were between 60 and 70 years old. Estrogen receptors (ER), progesterone receptors (PR), pS2 and cathepsin D cytosolic levels were determined, as well as levels of epidermal growth factor receptor (EGFR) in cell surfaces. Likewise, size, axillary lymph node involvement, distant metastasis, histological grade, ploidy and cellular S-phase fraction were also considered as variables of the study. RESULTS IDCs in women older than 70 had greater size (p<0.001), global S-phase (p = 0.009) and number of axillary lymph nodes involved (p = 0.002). Likewise, these tumors showed more frequently distant metastasis (p = 0.001) and S-phase values >14% (p = 0.093). However, when we considered only women referred from BCS, no differences in the parameters studied between women older than 70 and those aged between 60 and 70 years were observed. When only patients coming from BC were considered, women older than 70 had a greater number of axillary lymph nodes involved (p= 0.027). Patients older than 70 years from BC showed greater size (p= 0.054) and more common distant metastasis (p= 0.075) than those from BCS. Also, patients between 60 and 70 referred from BC had tumors with greater size (p <0.001), nodal involvement (p= 0.022), number of lymph nodes involved (p= 0.022) and distant metastasis (p= 0.048) than those from BCS with the same age. CONCLUSIONS Our results suggest that IDCs in women older than 70 years show clinical and biological features associated with a worse behaviour. However, this is only observed in women referred from BC but not in those coming from BCS. For this reason, the patient's referral site seems to be essential for the observed clinical and biological differences of breast carcinomas in the elderly.
Collapse
Affiliation(s)
- Alvaro Ruibal
- Laboratorio de Biología Tumoral FJD. Departamento de Medicina Nuclear. Fundación Jiménez Díaz. Fundación Tejerina. Madrid. Spain.
| | | | | |
Collapse
|