Treatment Minimization in Older Patients With Early-Stage Breast Cancer

A Comprehensive Review on Current Knowledge and Future Potential of Topical Therapies in Breast Cancer Treatment

Breast cancer remains one of the most prevalent malignancies among women globally. Despite advances in therapeutic options, the prognosis often remains challenging. Breast cancer typically originates in the epithelial lining of glandular tissue ducts (85%) or lobules (15%). Initially confined to these areas (in situ), it generally remains asymptomatic and poses little risk of metastasis. The primary treatments for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Although these interventions have advanced significantly and have improved patient survival rates, they are connected with numerous im mediate and long-term side effects. Effective breast cancer treatment aims to maximize efficacy while minimizing adverse effects. Given that many breast cancers are specific to the breast, developing safe and targeted therapeutic strategies will be of benefit. This review examined the current literature on the effectiveness of topical therapies for breast cancer. Studies and clinical trials were evaluated that have investigated these treatments, focusing on their safety, ease of application, and patient acceptance. Recently, topical drug delivery is transforming breast cancer therapy, offering precision and reduced systemic toxicity. Emu oil-enhanced tamoxifen showed superior transdermal effectiveness, while raloxifene gel achieved 2.77 times greater bioavailability than oral forms. Tamoxifen nanoemulgels and microneedle arrays with resveratrol further enhanced localized delivery, These therapies have gained patient acceptance due to their non-invasive nature, lack of gastrointestinal side effects, ease of application, and favourable safety and therapeutic profiles and setting a new benchmark for innovative and patient-friendly treatments. This review summarizes the findings from various studies, highlighting the benefits and limitations of topical therapies. Topical therapies offer a promising noninvasive option for breast cancer treatment with fewer side effects. These treatments have shown favorable therapeutic and safety profiles, making them an attractive option for patients.

Treating Positive Axillary Disease in Elderly Breast Cancer Patients: The Impact of Age on Radiation Therapy

Introduction

Breast cancer is the second most common cause of cancer death in females, and 30% of these patients are over the age of 70 years. Studies have shown deviation from the standard treatment paradigms in the elderly, especially in regard to radiation treatment.

Methods

We performed a retrospective chart review on 118 patients over the age of 70 years diagnosed with breast cancer and pathologically proven axillary disease over an 8-year period at an urban academic hospital to examine which patient factors influenced radiotherapy.

Results

Increasing patient age was associated with a decrease in the probability of receiving radiotherapy, while HER2-negative patients were more likely to receive radiation. Neither race, number of coexisting medical conditions, or insurance status showed any influence on radiation treatment.

Conclusion

Patient age has a significant influence if elderly patients with axillary disease receive radiotherapy. Further investigation and validation are needed to understand why chronological age rather than biological age influences treatment modalities.

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Background

The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in “real-life” situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France.

Methods

1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging.

Results

The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment.

Conclusion

This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.