scholarly journals Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Sereen Iweir ◽  
Rashid Abdel-Razeq ◽  
Fadwa Abdel Rahman ◽  
Hanan Almasri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Older Patients ◽  
Disease Free Survival ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Younger Patients ◽  
Significant Difference

AbstractIn developing countries, breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. The study involved two cohorts; older patients (≥ 65 years, n = 553) and younger ones (≤ 40 years, n = 417). Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Compared to younger patients, older patients were more likely to present with advanced-stage disease (20.6% vs. 15.1%, p = .028). However, among those with non-metastatic disease, younger patients tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p < .001), T-3/4 (28.2% vs. 13.8%, p < .001) and HER2-positive disease (29.3% vs. 16.3%, p < .001). The 5-year overall survival (OS) rate was significantly better for the younger (72.1%) compared to the older (67.6%), p = .035. However, no significant difference was observed in disease-free survival (DFS) between the two groups.In conclusion, younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was not insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients: A regional perspective.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18604-e18604
Author(s):  
Hikmat Abdel-Razeq ◽  
Sereen Iweir ◽  
Rashid Abdel-Razeq ◽  
Fadwa Abdel Rahman ◽  
Hanan Almasri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Older Patients ◽  
Young Cohort ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Younger Patients

e18604 Background: In developing countries, breast cancer treatment outcomes may be uniquely affected by the tendency of breast cancer patients to develop the disease at a much younger age than the worldwide average. Contrarily, older patients tend to present with multiple comorbidities that complicate their outcomes and influence their treatment options and decisions. This study will be the first to investigate the dichotomies between older and young breast cancer patients in our region. Methods: The study was based on data collected from the cancer registry of our institution for breast cancer patients 65 years or older (n = 553), and patients 40 years or younger (n = 417) at time of diagnosis. Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Results: A total of 970 patients were included in the final analysis. Compared to younger patients, older ones were more frequently diagnosed with distal metastasis; 20.6% compared to 15.1%, p =0.028. However, among patients with non-metastatic disease, younger ones tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p< 0.001), T-3/4 (28.2% vs. 13.8%, p< 0.001) and HER2-positive disease (29.3% vs. 16.3%, p< 0.001). A higher percentage of patients from the young cohort underwent surgery (85.4%) when compared to the older group (74.9%), p< 0.001. More patients in the older group had mastectomy than did younger patients (67.5% versus 40.2%, p< 0.001), while breast conserving surgery (BCS) was performed on almost a third in each cohort, p= 0.245. Skin-sparing, with or without, nipple-sparing mastectomies (SSMs) along with breast reconstruction surgery were more frequently performed on younger patients than they were on the older patients. After a median follow-up of 59 months for the younger patients and 45 months for the older ones, the 5-year OS rate of the older patients was 67.6% compared to 72.1% for the younger patients, p= 0.035. However, the 5-year DFS rates of the two cohorts were not statistically different at 63.9% for the older group and 60.7% for the young patients, p= 0.31. The survival of patients with non-metastatic disease was also compared among both groups; the 5-year OS among the younger patients was significantly higher (83.6% compared to 78.8% among the older patients, p= 0.046). Survival was better among the younger patients across many clinical and pathological characteristics. Conclusions: Younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Barriers to Clinical Trial Participation by Older Women With Breast Cancer

2003 ◽  
Vol 21 (12) ◽  
pp. 2268-2275 ◽  
Author(s):  
M. Margaret Kemeny ◽  
Bercedis L. Peterson ◽  
Alice B. Kornblith ◽  
Hyman B. Muss ◽  
Judith Wheeler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Cancer Patients ◽  
Older Patients ◽  
Disease Stage ◽  
Trial Participation ◽  
Breast Cancer Patients ◽  
Retrospective Case ◽  
Younger Patients ◽  
Significant Difference

Purpose: Although 48% of breast cancer patients are 65 years old or older, these older patients are severely underrepresented in breast cancer clinical trials. This study tested whether older patients were offered trials significantly less often than younger patients and whether older patients who were offered trials were more likely to refuse participation than younger patients. Patients and Methods: In 10 Cancer and Leukemia Group B institutions, using a retrospective case-control design, breast cancer patients eligible for an open treatment trial were paired: less than 65 years old and ≥ 65 years old. Each of the 77 pairs were matched by disease stage and treating physician. Patients were interviewed as to their reasons for participating or refusing to participate in a trial. The treating physicians were also given questionnaires about their reasons for offering or not offering a trial. Results: Sixty-eight percent of younger stage II patients were offered a trial compared with 34% of the older patients (P = .0004). In multivariate analyses, disease stage and age remained highly significant in predicting trial offering (P = .0008), when controlling for physical functioning and comorbidity. Of those offered a trial, there was no significant difference in participation between younger (56%) and older (50%) patients (P = .67). Conclusion: In a multivariate analysis including comorbid conditions, age and stage were the only predictors of whether a patient was offered a trial. The greatest impediment to enrolling older women onto trials in the setting of this study was the physicians’ perceptions about age and tolerance of toxicity.

MRI versus breast-specific gamma imaging (BSGI) in the detection of synchronous breast cancer: A prospective head-to-head trial.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 72-72
Author(s):  
L. J. Kirstein ◽  
J. L. Keto ◽  
D. P. Sanchez ◽  
T. Fulop ◽  
I. Cohen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Imaging Study ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Imaging Findings ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Significant Difference

72 Background: Literature suggests that MRI identifies additional mammographically and sonographically occult cancers in 8-10% of newly diagnosed breast cancer patients. We have reported comparable sensitivity of BSGI to MRI in the detection of the known index cancer. We sought to prospectively compare BSGI to MRI in the identification of additional occult malignancies in newly diagnosed breast cancer patients. Methods: Patients with newly diagnosed breast cancer from June 1, 2009 through February 4, 2011 were consented for an IRB approved protocol in which they underwent both breast MRI and BSGI. Each imaging study was read by a dedicated breast radiologist, with one reading all MRI, and another reading all BSGI studies. All subsequent biopsies were performed percutaneously under image guidance and reviewed by dedicated pathologists. The identification of additional occult breast cancers by MRI and BSGI was compared. Results: Eighty-five patients underwent both MRI and BSGI. Twenty-one patients elected to undergo mastectomy without further management of imaging findings and were excluded, leaving 64 eligible patients. No additional lesions were found in 22 patients. Twenty-one patients had benign pathology on biopsied imaging findings. Metastatic axillary lymph nodes, satellite lesions or larger extent of disease was identified in 11 patients. Eleven occult breast cancers were identified in 10 patients (15.6%), 6 on MRI alone (9.4%), 3 on BSGI alone (4.7%), and 2 by both modalities (3.1%). There was no significant difference in the identification of occult cancer between MRI and BSGI (chi-square 0.77, p>0.1; Table). Conclusions: BSGI has previously been shown to be as sensitive as MRI for detecting known invasive and in situ breast carcinoma. This study shows that BSGI is equally sensitive to MRI in the detection of synchronous mammographically and sonographically occult cancers in newly diagnosed breast cancer patients. Further research is needed to identify the false positive rates of BSGI and the effect on surgical management in comparison to MRI. [Table: see text]

scholarly journals MicroRNAs Regulating Tumor Immune Response in the Prediction of the Outcome in Patients With Breast Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Konstantina Thomopoulou ◽  
Chara Papadaki ◽  
Alexia Monastirioti ◽  
George Koronakis ◽  
Anastasia Mala ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Free Survival ◽  
Disease Free ◽  
Line Chemotherapy

MicroRNAs (miRNAs) are key regulators in immune surveillance and immune escape as well as modulators in the metastatic process of breast cancer cells. We evaluated the differential expression of plasma miR-10b, miR-19a, miR-20a, miR-126 and miR-155, which regulate immune response in breast cancer progression and we investigated their clinical relevance in the outcomes of breast cancer patients. Plasma samples were obtained from early (eBC; n = 140) and metastatic (mBC; n = 64) breast cancer patients before adjuvant or first-line chemotherapy, respectively. Plasma miRNA expression levels were assessed by qRT-PCR. We revealed a 4-miRNA panel consisted of miR-19a, miR-20a, miR-126, and miR-155 able to discriminate eBC from mBC patients with an AUC of 0.802 (p &lt; 0.001). Survival analysis in eBC patients revealed that low miR-10b and miR-155 expression was associated with shorter disease free survival (disease free survival; p = 0.012 and p = 0.04, respectively) compared to high expression. Furthermore, miR-126 expression was associated with shorter overall survival (overall survival; p = 0.045). In multivariate analysis the number of infiltrated axillary lymph nodes and low miR-10b expression independently predicted for shorter DFS (HR: 2.538; p = 0.002 and HR: 1.943; p = 0.033, respectively) and axillary lymph nodes and low miR-126 for shorter OS (HR: 3.537; p = 0.001 and HR: 2.558; p = 0.018). In the subgroup of triple negative breast cancer (TNBC) patients, low miR-155 expression independently predicted for shorter DFS (HR: 5.056; p = 0.037). Accordingly in mBC, patients with low miR-10b expression had shorter progression free survival and OS compared to patients with high expression (p = 0.0017 and p = 0.042, respectively). In multivariate analysis, recurrent disease and low miR-10b expression independently predicted for shorter PFS (HR: 2.657; p = 0.001 and HR: 1.920; p = 0.017, respectively), whereas performance status two independently predicted for shorter OS (HR: 2.031; p = 0.03). In summary, deregulated expression of circulating miRNAs involved in tumor and immune cell interactions evaluated before adjuvant and 1st-line chemotherapy can distinguish disease status and emerge as independent predictors for outcomes of breast cancer patients.

scholarly journals Intra-mammary lymph nodes, an overlooked breast cancer prognostic tool?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tarek Hashem ◽  
Ahmed Abdelmoez ◽  
Ahmed Mohamed Rozeka ◽  
Hazem Abdelazeem
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Percutaneous Biopsy ◽  
Preoperative Imaging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Surgical Data

Abstract Background Due to the high variability of incidence and prevalence of intra-mammary lymph nodes (IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer might aid in proper therapeutic decision-making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013 and 2019. Radiological, pathological, and surgical data were studied. Results Intra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phyllodes tumors and two cases had ductal carcinoma in situ (DCIS). All ten cases were excluded. The remaining 90 cases all had invasive breast cancer and were divided into two groups: one group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumor size in pathology (4.7 cm), larger mean size of the IMLN in pathology (1.7 cm), higher incidence of lympho-vascular invasion (65.9%), and higher rate of extracapsular extension in axillary lymph nodes (57.4%). In addition, the pathological N stage was significantly higher in the malignant IMLN group. Conclusion Clinicians frequently overlook intra-mammary lymph nodes. More effort should be performed to detect them during preoperative imaging and during pathological processing of specimens. A suspicious IMLN should undergo a percutaneous biopsy. Malignant IMLNs are associated with advanced pathological features and should be removed during surgery.

scholarly journals Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients

2014 ◽  
Vol 12 (1) ◽  
Author(s):  
Emerson Wander Silva Soares ◽  
Hildebrando Massahiro Nagai ◽  
Luis César Bredt ◽  
Ademar Dantas da Cunha ◽  
Reginaldo José Andrade ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients

scholarly journals Intra-mammary Lymph Nodes, an Overlooked Prognostic Tool?

2020 ◽  
Author(s):  
Tarek Hashem ◽  
Ahmed Abdel Moez ◽  
Ahmed Rozeka ◽  
Hazem Abdel Azeem
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Tumour Size ◽  
Preoperative Imaging ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pathological Features ◽  
Breast Cancer Patients ◽  
Duct Carcinoma ◽  
Surgical Data

Abstract BackgroundDue to the high variability of incidence and prevalence of intra-mammary lymph nodes(IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer, might aid in proper therapeutic decision making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013-2019. Radiological, pathological and surgical data were studied.ResultsIntra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phylloides tumors and two cases had duct carcinoma in situ. All ten cases were excluded. The remaining 90 cases had all invasive breast cancer and were divided into two groups. One group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumour size (4.7 cm) , larger mean size of the IMLN (1.4 cm), higher incidence of lymphovascular invasion( 65.9%) and a higher rate of extracapsular extension in axillary lymph nodes (57.4%). All these criteria were statistically significant. In addition the pathological N stage was significantly higher in the malignant IMLNs group.ConclusionIntra-mammary lymph nodes are frequently overlooked by clinicians. More effort should be done to detect them during preoperative imaging, and during pathological processing of specimens. A suspicious IMLN should be biopsied by FNAC . Malignant IMLN are associated with advanced pathological features and should be removed during surgery.

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