Surgery for breast cancer

Management of elderly patients with breast cancer: the time for surgery

INTRODUCTION

Most patients with breast cancer are likely to benefit from local treatment (surgery and/or radiotherapy). Historically an arbitrary cut-off of 70 years has been widely used, above which women were considered for tamoxifen-only treatment. We looked at the proportion of our patients who did not have early surgery for breast cancer to see if this cut-off might have been used too rigidly, resulting in suboptimal treatment of some patients over 70 years of age. A step change in the rate of surgical treatment around age 70 was sought as evidence.

METHOD

A total of 2209 consecutive patients with confirmed histological diagnosis of breast cancer were identified; 677 of these did not have surgery within 3 months of diagnosis. Analysis determined age group distribution and the reasons for no surgery or delayed surgery.

RESULTS

A step increase in the number of patients not undergoing early surgery was clearly seen at 70 years of age.

CONCLUSION

Age may have been used too rigidly to decide local treatment for elderly patients with breast cancer. Comprehensive multidisciplinary assessment is needed to make informed decisions and to optimize management of elderly patients.

Incidence of chromosomes 1 and 17 aneusomy in breast cancer and adjacent tissue: an interphase cytogenetic study

BACKGROUND

Characterization of the biopathologic events underlying the early steps of breast carcinogenesis may have a dramatic impact on reducing breast cancer mortality. Genes involved in breast tumorigenesis are localized on chromosomes 1 and 17, and numeric aberrations of these chromosomes have been correlated with breast cancer tumorigenesis and progression. According to the field cancerization hypothesis, specific chromosome aberrations may be present in breast cancer and in normal-appearing adjacent tissue. The latter changes reflect the genomic damage that follows longterm carcinogenic exposure and precede the morphologically detectable neoplastic transformation. We hypothesize that detection of these aberrations in benign breast epithelium may provide a tool for molecular risk assessment.

STUDY DESIGN

Using fluorescence in situ hybridization with centromere-specific probes, we determined the status of chromosomes 1 and 17 in fresh imprints of 28 samples of primary tumors and 54 samples of their surrounding uninvolved parenchyma taken from patients undergoing operations for breast carcinoma. Ten contralateral breast biopsy specimens collected from patients with previous breast carcinoma were also evaluated as a surrogate of a high-risk group to rule out the hypothesis that chromosomal aneusomy in tumor-adjacent tissue could be related to a paracrine effect of the primary tumor. Ten samples of benign breast tissue taken from patients at low risk were used as controls to define tolerance limits for aneusomy definition.

RESULTS

Using threshold values of 40% of signal loss and 13% of signal gain to define chromosome aneusomy (ie, mean + 3 SDs of the control group signals), we found the following: 1) almost all primary breast tumors were aneusomic for chromosomes 1 and 17; 2) primary breast tumor and adjacent uninvolved parenchyma shared the same pattern of chromosomes 1 and 17 aneusomy in 66.7% of patients; and 3) chromosomes 1 and 17 aneusomies in contralateral benign breast samples from high-risk patients were not different from those in primary breast tumor or adjacent tissue samples.

CONCLUSIONS

These results suggest that chromosomes 1 and 17 aneusomy may represent an intermediate biomarker of breast tumorigenesis potentially useful to detect patients at high risk of breast carcinoma who may benefit from preventive interventions.