Breast cancer in the elderly.

e11506 Background: Breast cancer is one of the age-related tumors that accompany with population ageing and approximately 50 % of this disease occur in 65 years of age or older and also more than 30 % occur after age of 70. This study aims to examine characteristics of patients with breast cancer 65 years or older. Methods: The study was carried out on a series of 177 breast cancer patient followed up at our outpatient clinic who are 65 years or older chosen among 848 breast cancer patients during the period 1995-2012. Physical examination, annual chest x-ray, mammography, abdominal ultrasonography and bone scan were the tools to assess the disease status. SPSS 16 was used. Results: The mean age was 70.8 years old (range 65-85 years). There was only one patient whose age is older than 85 years. 85 % of histopathology was infiltratif ductal carcinoma. 83 % of patients underwent mastectomy while 92 % was performed axillary dissection. 56 % had node positivity and 54 % had 2 cm or bigger tumor. ER/PR status was both negative in 54 women (30 %) and both positive in 82 of them. Also cerbB2 was negative in most of the patients (70 %). At the diagnosis, 20 patients (11.3 %) had metastatic disease and 157 were without metastases. Totally 44 patients (32 %) had metastatic disease and most of them (29 patients) had bone disease. Only 52 did not have endocrine therapy with 48 % had tamoxifen as a part of hormonal therapy. Most of them received radiotherapy (54 %). DFS was within 7-182 months with a median of 54 months. PFS was between 2-60 months and patients had a median OS about 61 months. 30 patients died because several causes owing to ageing causes. Conclusions: Breast cancer is the most significant cancer of women and the screening modalities with adjuvant postoperative therapies have increased survival. Acute and chronic medical conditions, nutritional status, poly-pharmacy, level of activity, disease-spesific symptoms and patient decision all need to be taken into consideration. Both in early and advanced stages of the disease, quality of life and related aspects have critical importance in elderly women who have more limited life-expectancy. It is also essential that women with breast cancer 65 years and older be included in trials and that they be recommended the best therapies available.

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Breast Cancer Reconstruction in the Elderly

The American Surgeon ◽

10.1177/000313481107701235 ◽

2011 ◽

Vol 77 (12) ◽

pp. 1640-1643 ◽

Cited By ~ 17

Author(s):

Marissa Howard-Mcnatt ◽

Clay Forsberg ◽

Edward A. Levine ◽

Anthony Defranzo ◽

Malcolm Marks ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Elderly Women ◽

Ductal Carcinoma ◽

Tissue Expander ◽

Perforator Flap ◽

The Elderly ◽

Immediate Breast Reconstruction ◽

Tram Flap ◽

Local Skin

Mastectomy is a surgical choice for breast cancer, yet breast reconstruction is underused in women older than age 60 years. Because of a paucity of information examining breast cancer reconstruction in the elderly, we sought to review our experience. By retrospective chart review, we evaluated 89 women older than 60 years having mastectomy and reconstruction from January 1998 to June 2008. Mean patient age was 65 years (range, 60 to 74 years). The majority (41%) had Stage 1 disease or Stage 2 (30%). Ductal carcinoma in situ comprised 25 per cent and Stage 3 totaled 2 per cent. Mastectomy for ipsilateral breast tumor recurrence after radiation therapy and lumpectomy comprised 11 per cent. Most underwent immediate breast reconstruction (89%). Reconstructive techniques included two-stage implant (58%), transverse rectus abdominus musculocutaneous (TRAM) flap (10%), latissimus dorsi musculocutaneous flap with implant (2%), or deep inferior epigastric perforator flap (1%). Complications included a 12 per cent infection rate, removal of two expanders resulting from exposure, one TRAM failure, and one TRAM required debriding. Four patients undergoing mastectomy with tissue expander had radiation resulting in one expander being removed. One local skin recurrence was treated with removal of implant and skin resection. Two patients have died from metastatic disease. Age should not be a contraindication for breast reconstruction in elderly women.

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PAI-1 is independent prognostic factor in the elderly breast cancer patients

European Journal of Cancer ◽

10.1016/s0959-8049(02)80358-6 ◽

2002 ◽

Vol 38 (11) ◽

pp. S111

Author(s):

B Pajk

Keyword(s):

Breast Cancer ◽

Prognostic Factor ◽

Cancer Patients ◽

The Elderly ◽

Independent Prognostic Factor ◽

Breast Cancer Patients ◽

Pai 1

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A self completed questionnaire is better than routine follow up for eliciting symptoms of recurrent or metastatic disease in breast cancer patients

European Journal of Cancer ◽

10.1016/s0959-8049(02)80462-2 ◽

2002 ◽

Vol 38 (11) ◽

pp. S140

Author(s):

S Bower

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Metastatic Disease ◽

Breast Cancer Patients ◽

Better Than

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02219-0 ◽

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.

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Breast Cancer in the Elderly

Journal of Clinical Oncology ◽

10.1200/jco.2006.10.2079 ◽

2007 ◽

Vol 25 (14) ◽

pp. 1882-1890 ◽

Cited By ~ 117

Author(s):

Diana Crivellari ◽

Matti Aapro ◽

Robert Leonard ◽

Gunter von Minckwitz ◽

Etienne Brain ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Life Expectancy ◽

Cancer Patients ◽

Disease Free Survival ◽

Cost Benefit ◽

The Elderly ◽

Breast Cancer Patients ◽

Younger Women ◽

Based Medicine

Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.

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Screening for metastatic disease in newly diagnosed breast cancer patients

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(08)70355-0 ◽

2008 ◽

Vol 6 (7) ◽

pp. 61

Author(s):

E. Una ◽

M.J. Borau ◽

J. Nieto ◽

A. De la Torre ◽

G. Fernandez ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Metastatic Disease ◽

Newly Diagnosed ◽

Breast Cancer Patients

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Prognostic subset of metastatic and non-metastatic luminal B breast cancer (LBBC) subtype based on Ki67 index.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12570 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12570-e12570

Author(s):

Lalnun Puii ◽

Lalram Sangi ◽

Hrishi Varayathu ◽

Samuel Luke Koramati ◽

Beulah Elsa Thomas ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Disease ◽

Ki67 Index ◽

Breast Cancer Patients ◽

Luminal A ◽

Her2 Positive ◽

Ki 67 ◽

Luminal B ◽

Therapeutic Implications ◽

Significant Difference

e12570 Background: Gene expression profiling for breast cancer has classified ER positive subtype into luminal A and luminal B. Luminal B breast cancer (LBBC) have a higher proliferation and poorer prognosis than luminal A tumors. Ki-67 index is the commonly used proliferation marker in breast cancer; however Ki67 expression can also be used to identify a subset of patients among LB with a favorable prognosis. This study attempts to verify this subset of LBBC patients based on DFS and PFS in non-metastatic and metastatic patients respectively. Methods: We retrospectively analyzed 80 IDC breast cancer patients diagnosed in 2013-2016 with complete follow-up till January-2021. We defined LBBC as ER+, PR+ or PR- , HER2+ or HER2- with a Ki67 index >20%. PFS was considered as the endpoint in patients presenting with metastatic disease whereas DFS was used in non-metastatic disease. The cut-off for ki67 was calculated using an X-tile plot (version 3.6.1, Yale University) by dividing Ki67 data into two populations: low and high, with randomized 1:1 “training” and “validation” cohorts. Results: Median age was 51.5 years. 18.7% (n=15) presented with metastasis at the time of diagnosis and their overall median PFS was found to be 25.8 months. The incidence of HER2 positive LBBC was found to be 15% (n=12) and none of them were found to be presented with metastasis. Survival and frequency of various sub groups in our study are enlisted in the given table. We estimated a Ki67 cut-off of 30% in patients with upfront metastatic disease and PFS was found to be higher in <30% compared to a Ki67 index >30% (38.9 months vs 19.7 months, p-0.002). Overall median DFS was not achieved in non-metastatic group (Mean DFS: 64.7 months) where as a statistically significant difference was observed in the survival of HER2 positive (median DFS: 53.5 months, mean DFS: 50.9) than HER2 negative patients (median DFS not achieved, mean: 66.97 months) ( p-0.021). We obtained a Ki67 cut-off of 32% in non- metastatic group and mean DFS was found to be higher in Ki67<32% (69 months) compared to Ki67>32% (61.4 months), however it failed to exhibit a statistically significant relationship ( p-0.373). Conclusions: Our study indicates that a subset of patients exists within metastatic and non-metastatic LBBC with differing prognosis based on Ki67. Larger studies are further required to confirm the findings and therapeutic implications.[Table: see text]

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Final report of Breast Cancer Care Registry at the Kenyatta National Hospital, Nairobi.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12552 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12552-e12552

Author(s):

Nicholas Anthony Othieno-Abinya ◽

Alice Musibi ◽

Catherine Nyongesa ◽

Benjamin Njihia ◽

Andrew Gachii ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Disease ◽

Ductal Carcinoma ◽

Clinical Care ◽

Significant Proportion ◽

Relative Survival ◽

Final Report ◽

Early Disease ◽

National Hospital ◽

Kenyatta National Hospital

e12552 Background: Breast cancer is the commonest cancer among women in Kenya. We wanted to examine breast cancer seen at the Kenyatta National Hospital in relation to local factors that influence prognosis and quality of life, local variations in treatment and outcomes; describe the clinical care patterns, monitor the safety of the therapies provided to patients in a routine clinic setting. Methods: A prospective study of patients with breast cancer between 11.08.2011 and 11.09.2014 inclusive. Data included demographic details, diagnostic and staging procedures, stage, treatment and outcome. Estimates of relative survival used period approach. hi-square tests and analysis of variance (ANOVA) were utilised to make comparisons. Cross sectional data are presented in proportions, means and medians. Results: Four hundred patients were included, age range 20 to 83, median 49 years. Out 312, 65 (20.8%) were obese. Eight of 397 (2%) were smokers and 22(5.5%) took alcohol. Early disease was diagnosed in 269 out of 354 (76%) and metastatic disease in 85(24%). Breast lump presented in 388 out of 400 (97%), breast pain in 104 out of 388 (26.8%). Fifteen of 394 (3.8%) had second breast cancer, 4 (1%) had had ovarian cancer and 9 (2.3%) had had had other malignancy. History of breast cancer in first and second-degree relative was elicited in 41 out of 394 (10.4%). Ductal carcinoma NOS was commonest in 343 (88.2%), lobular carcinoma in 9(2.5%). Cases by T stage were T1 - 25(7.2%), T2 -130(37.4%), T3 - 96(27.6%), T4 - 87(25%). Of 322 cases, 187(58.1%) were ER positive and 175 (54.4%) PR positive. Her2 positive cases were 78 out of 322 (24.2%). Neo adjuvant and adjuvant chemotherapy mainly consisted of combinations of cyclophosphamide and doxorubicin [AC] +/- a taxane[AC→T] ( mainly by medical oncologists) or AC+ 5-FU [CAF] (mainly by clinical oncologists). Of 305 cases 272 (89.2%) completed adjuvant therapy, 8(2.6%) died during treatment. Median overall survival was 57.1 months (95% CI; 55.6 to 59.5 months). For metastatic disease, median PFS was worse for patients < 40 years. Conclusions: Pathology and biology mirrored global situation, over 75% of patients had non metastatic disease. A significant proportion of early disease patients did not complete treatment.

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Comparison of free radicals in blood in pre-operative and post-operative phases of breast malignancies: a clinicopathological study

International Surgery Journal ◽

10.18203/2349-2902.isj20195972 ◽

2019 ◽

Vol 7 (1) ◽

pp. 210

Author(s):

Abhishek Jina ◽

U. C. Singh

Keyword(s):

Breast Cancer ◽

Free Radicals ◽

Breast Carcinoma ◽

Ductal Carcinoma ◽

Lipid Peroxide ◽

P Value ◽

Breast Cancer Patients ◽

Medical College ◽

Surgery Department

Background: Various factors have been identified as influencing factors of breast cancer. The free radicals can cause increased oxidative stress by negatively affecting the body’s nucleic acids, lipids and proteins leading to various illnesses including cancer. Therefore, this study was aimed at discovering the progress of treatment of breast carcinoma by exploring the connections of the disease with free radical injury.Methods: The present study was conducted among 30 breast carcinoma patients received in the surgery department of BRD Medical College Gorakhpur. Determination of the levels superoxide dismutase (SOD) (the procedure of photoluminescence), catalase (method of Cavarochi) and the lipid peroxidise was done. The results were presented as mean and standard error (SE). P value of <0.05 was considered as statistically significant.Results: Among the total participants, 73% patients had infiltrating ductal carcinoma and 27% patients had intraductal carcinoma. The dismutase levels showed an increase in the post-operative patients for both the groups. The catalase levels and the lipid peroxide levels showed a reduction in the postoperative patients (p<0.05).Conclusions: The present study result showed that the low amounts of SOD and catalase may not be sufficient to detoxify high amounts of free radicals. The administration of catalase could help in reducing the symptoms. Though, low amounts of SOD and catalase may not be sufficient to detoxify high amounts of free radicals. The administration of enzymes could help in the treatment of breast cancer patients.

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