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Daly GR, Dowling GP, Said M, Qasem Y, Hembrecht S, Calpin GG, AlRawashdeh MM, Hill ADK. Impact of Sentinel Lymph Node Biopsy on Management of Older Women With Clinically Node-Negative, Early-Stage, ER+/HER2-, Invasive Breast Cancer: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2024:S1526-8209(24)00212-X. [PMID: 39214843 DOI: 10.1016/j.clbc.2024.07.012] [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: 07/09/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
In 2016 the Choosing Wisely guidelines advised against routine performance of a sentinel lymph node biopsy (SLNB) in women ≥ 70 years of age with clinically node negative (cN0), early-stage, oestrogen receptor positive/ human epidermal growth factor receptor 2 negative (ER+/HER2-), invasive breast cancer. The argument in favour of its continued performance is that it may serve as a useful guide for subsequent management. This systematic review was performed in accordance with the PRISMA guidelines. Studies reporting on rate of adjuvant chemotherapy, adjuvant radiotherapy and performance of completion axillary lymph node dissection (cALND) post SLNB in women aged ≥ 65 years with cN0, early-stage, ER+/HER2-, invasive breast cancer were included. A random effects meta-analysis was performed with summary estimates made using the Mantel-Haenszel method. Dichotomous outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Ten retrospective studies across 4 countries. Of 105,514 patients, 15,509 had a positive SLNB and 90,005 had a negative SLNB. On meta-analysis, a positive SLNB was significantly associated with receipt of adjuvant chemotherapy (OR 4.64 (95% CI 3.18, 6.77), P < .00001), adjuvant radiotherapy (1.71 (95% CI 1.18, 2.47), P = .005) and undergoing completion axillary lymph node dissection (OR 68.97 (95% CI, 7.47, 636.88), P = .0002). Adjuvant treatment decisions continue to be influenced by SLNB positivity in the era of the Choosing Wisely guidelines. The effects of a positive SLNB and subsequent treatments on outcomes remain inconclusive. However, it is likely clinicians are continuing to over-investigate and over-treat this cohort.
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Affiliation(s)
- Gordon R Daly
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Gavin P Dowling
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Mohammad Said
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yazan Qasem
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sandra Hembrecht
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gavin G Calpin
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Ma'en M AlRawashdeh
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Prathap R, Kirubha S, Rajan AT, Manoharan S, Elumalai K. The increasing prevalence of cancer in the elderly: An investigation of epidemiological trends. Aging Med (Milton) 2024; 7:516-527. [PMID: 39234197 PMCID: PMC11369332 DOI: 10.1002/agm2.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/21/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Cancer poses a significant health threat to the elderly, accounting for a substantial proportion of cancer patients aged 65 and above. As life expectancy continues to rise and the population ages, the incidence of cancer in the elderly is expected to increase further. Age is a major risk factor for the majority of common cancers, with the incidence and prevalence rising as individuals grow older. Factors such as chemoprevention and environmental carcinogen elimination may influence the process of carcinogenesis. Studies reveal that the incidence and mortality rates of various cancers in the elderly and extremely old individuals are on the rise worldwide, with most types peaking around the age of 75 to 90, followed by a sharp decline. Birth cohort and period effects also play a complex role in the connection between aging and cancer risk. Clinical trials often exclude older individuals, limiting our understanding of cancer treatments' effects on this particular age group. More research is needed to focus on the unique requirements of older adults with cancer.
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Affiliation(s)
- Ramya Prathap
- Department of Pharmaceutical Chemistry, Saveetha College of PharmacySaveetha Institute of Medical and Technical SciencesChennaiIndia
| | - Sherlin Kirubha
- Department of Pharmaceutical Chemistry, Saveetha College of PharmacySaveetha Institute of Medical and Technical SciencesChennaiIndia
| | - Aravindhan Thiyaga Rajan
- Department of Pharmaceutical Chemistry, Saveetha College of PharmacySaveetha Institute of Medical and Technical SciencesChennaiIndia
| | - Santhosh Manoharan
- Department of Pharmaceutical Chemistry, Saveetha College of PharmacySaveetha Institute of Medical and Technical SciencesChennaiIndia
| | - Karthikeyan Elumalai
- Department of Pharmaceutical Chemistry, Saveetha College of PharmacySaveetha Institute of Medical and Technical SciencesChennaiIndia
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McKevitt E, Cheifetz R, DeVries K, Laws A, Warburton R, Gondara L, Lohrisch C, Nichol A. Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy. Ann Surg Oncol 2021; 28:5950-5957. [PMID: 33817760 DOI: 10.1245/s10434-021-09839-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The SSO Choosing Wisely campaign recommended selective sentinel lymph node biopsy (SLNB) in clinically node-negative women aged ≥ 70 years with ER+ breast cancer. We sought to assess the association of SLNB positivity, adjuvant treatment, and survival in a population-based cohort. PATIENTS AND METHODS Women aged ≥ 70 years treated for ER+ HER2- breast cancer between 2010 and 2016 were identified in our prospective provincial database. Overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Kaplan-Meier analysis. Multivariable logistic regression was used to assess the association of SLNB positivity with use of adjuvant treatments and survival outcomes. RESULTS We identified 2662 patients who met study criteria. SLNB was positive in 25%. Increased use of chemotherapy (ChT), hormone therapy (HT), and radiotherapy (RT) was significantly associated with SLNB positivity. Five-year OS was 86%, and BCSS was 96% with median follow-up of 4.3 years. BCSS was worse with grade 3 disease (HR 4.1, 95% CI 2.1-8.1, p < 0.0001) and better with HT (HR 0.5 95% CI 0.3-0.9, p = 0.01). Patients with a positive SLNB treated without adjuvant therapy had lower BCSS (HR 3.2 95% CI 1.2-8.4, p = 0.017) than those with a negative SLNB, but patients with a positive SLNB treated with any combination of ChT, HT, and/or RT, had similar BCSS to those with a negative SLNB. CONCLUSIONS BCSS in this population was excellent at 96%, and BCSS was similar with negative and positive SLNB when patients received HT. SLNB can be omitted in elderly patients willing to take HT.
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Affiliation(s)
- Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, Vancouver, BC, Canada. .,Department of Surgery, BC Cancer, Vancouver, Canada. .,Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Rona Cheifetz
- Department of Surgery, BC Cancer, Vancouver, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Alison Laws
- Department of Surgery, University of Calgary, Alberta, Canada
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, Vancouver, BC, Canada.,Department of Surgery, BC Cancer, Vancouver, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Caroline Lohrisch
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Alan Nichol
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer, Vancouver, Canada
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