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

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.

Download Full-text

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

Scientific Reports ◽

10.1038/s41598-021-93676-w ◽

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.

Download Full-text

Barriers to Clinical Trial Participation by Older Women With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2003.09.124 ◽

2003 ◽

Vol 21 (12) ◽

pp. 2268-2275 ◽

Cited By ~ 297

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.

Download Full-text

Development and validation of nomograms for predicting axillary non-SLN metastases in breast cancer patients with 1–2 positive sentinel lymph node macro-metastases: a retrospective analysis of two independent cohorts

BMC Cancer ◽

10.1186/s12885-021-08178-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yang Yu ◽

Zhijun Wang ◽

Zhongyin Wei ◽

Bofan Yu ◽

Peng Shen ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Cancer Patients ◽

Early Breast Cancer ◽

Validation Cohort ◽

Positive Sentinel Lymph Node ◽

Axillary Lymph ◽

Pathological Features ◽

Breast Cancer Patients

Abstract Background It is reported that appropriately 50% of early breast cancer patients with 1–2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation. However, whether patients with 1–2 positive SLN macro-metastases could benefit from ALND remains unknown. The aim of our study was to develop and validate nomograms for assessing axillary non-SLN metastases in patients with 1–2 positive SLN macro-metastases, using their pathological features alone or in combination with STMs. Methods We retrospectively reviewed pathological features and STMs of 1150 early breast cancer patients from two independent cohorts. Best subset regression was used for feature selection and signature building. The risk score of axillary non-SLN metastases was calculated for each patient as a linear combination of selected predictors that were weighted by their respective coefficients. Results The pathology-based nomogram possessed a strong discrimination ability for axillary non-SLN metastases, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.727 (95% CI: 0.682–0.771) in the primary cohort and 0.722 (95% CI: 0.653–0.792) in the validation cohort. The addition of CA 15–3 and CEA can significantly improve the performance of pathology-based nomogram in the primary cohort (AUC: 0.773 (0.732–0.815) vs. 0.727 (0.682–0.771), P < 0.001) and validation cohort (AUC: (0.777 (0.713–0.840) vs. 0.722 (0.653–0.792), P < 0.001). Decision curve analysis demonstrated that the nomograms were clinically useful. Conclusion The nomograms based on pathological features can be used to identify axillary non-SLN metastases in breast cancer patients with 1–2 positive SLN. In addition, the combination of STMs and pathological features can identify patients with patients with axillary non-SLN metastases more accurately than pathological characteristics alone.

Download Full-text

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

Download Full-text

A logistic regression nomogram to predict axillary lymph node metastasis in early invasive breast cancer patients

10.26226/morressier.5b4709836f4cb30010951a6e ◽

2018 ◽

Author(s):

Parnaz Daneshpajouhnejad

Keyword(s):

Breast Cancer ◽

Logistic Regression ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Invasive Breast Cancer ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Metastasis

Download Full-text

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.

Download Full-text