Breast Cancer in the Elderly

2018 ◽  
Author(s):  
Catherine Pesce ◽  
Katharine Yao
Keyword(s):  
Breast Cancer ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Neoadjuvant Therapy ◽  
Breast Surgery ◽  
Survival Rates ◽  
The Elderly ◽  
Breast Cancer Patients ◽  
Younger Women ◽  
Key Words Breast

Elderly patients with breast cancer are more likely to present with more favorable tumor characteristics and molecular subtypes; however, outcomes are worse, with lower survival rates compared with younger women. Less use of screening, undertreatment, the frequency of comorbidities, and the lack of information in clinical trials on the use of systemic therapy in this population all likely play a role. Unless patients have a prohibitive risk for surgery or a life expectancy less than 5 years, surgery should be considered for elderly patients who are surgically resectable. Radiation and chemotherapy are less likely to be used in elderly patients; however, with an increase in the use of neoadjuvant therapy for breast cancer patients, recommendations or guidelines for neoadjuvant therapy for the elderly are needed. Further tools that can assist physicians with risk assessment of elderly patients for both surgery and adjuvant therapies are needed. A multidisciplinary discussion that includes discussion of the need for adjuvant therapy is necessary and should be balanced against the patient’s comorbidities and functional status when deciding on the best course of treatment for these patients. It should be emphasized that elderly patients should be offered standard treatments that nonelderly patients receive, and these recommendations should only be modified if there is limited life expectancy or other socioeconomic factors that influence whether patients can undergo standard treatments. This review contains 2 figures, 11 tables, and 60 references Key words: breast surgery, breast cancer in the elderly, elderly breast surgery, elderly oncology, geriatric breast surgery

Breast Cancer in the Elderly

2018 ◽  
Author(s):  
Catherine Pesce ◽  
Katharine Yao
Keyword(s):  
Breast Cancer ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Neoadjuvant Therapy ◽  
Breast Surgery ◽  
Survival Rates ◽  
The Elderly ◽  
Breast Cancer Patients ◽  
Younger Women ◽  
Key Words Breast

Elderly patients with breast cancer are more likely to present with more favorable tumor characteristics and molecular subtypes; however, outcomes are worse, with lower survival rates compared with younger women. Less use of screening, undertreatment, the frequency of comorbidities, and the lack of information in clinical trials on the use of systemic therapy in this population all likely play a role. Unless patients have a prohibitive risk for surgery or a life expectancy less than 5 years, surgery should be considered for elderly patients who are surgically resectable. Radiation and chemotherapy are less likely to be used in elderly patients; however, with an increase in the use of neoadjuvant therapy for breast cancer patients, recommendations or guidelines for neoadjuvant therapy for the elderly are needed. Further tools that can assist physicians with risk assessment of elderly patients for both surgery and adjuvant therapies are needed. A multidisciplinary discussion that includes discussion of the need for adjuvant therapy is necessary and should be balanced against the patient’s comorbidities and functional status when deciding on the best course of treatment for these patients. It should be emphasized that elderly patients should be offered standard treatments that nonelderly patients receive, and these recommendations should only be modified if there is limited life expectancy or other socioeconomic factors that influence whether patients can undergo standard treatments. This review contains 2 figures, 11 tables, and 60 references Key words: breast surgery, breast cancer in the elderly, elderly breast surgery, elderly oncology, geriatric breast surgery

Breast Cancer in the Elderly

2007 ◽  
Vol 25 (14) ◽  
pp. 1882-1890 ◽  
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.

scholarly journals Pathologic and Clinical Characteristics of Elderly Patients With Breast Cancer: A Retrospective Analysis of a Multicenter Study (Anatolian Society of Medical Oncology)

2014 ◽  
Vol 99 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Ali İnal ◽  
Tulay Akman ◽  
Sebnem Yaman ◽  
Selcuk Cemil Ozturk ◽  
Caglayan Geredeli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Older Patients ◽  
The Elderly ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Number Of Patients ◽  
Er Positive

Abstract There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.

COULD GENERAL SURGEONS WITH SPECIAL INTEREST IN BREAST SURGERY DELIVER A QUALITY SERVICE DESPITE A PARADIGM SHIFT TOWARDS SPECIALISATION? AN INDEPTH ANALYSIS OF QUALITY ASSESSMENT-BASED PRACTICE AT A GENERAL SURGEON-LED BREAST UNIT IN THE UNITED KINGDOM

2021 ◽  
pp. 43-48
Author(s):  
Pasupathy Kiruparan ◽  
Mariana Matias ◽  
Nanthesh Kiruparan ◽  
David Archampong ◽  
Debasish Debnath
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
United Kingdom ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Breast Surgery ◽  
Survival Rates ◽  
Breast Cancer Patients ◽  
The United Kingdom ◽  
General Surgeons

Background: Despite specialisation, a small subset of general surgeons continues to provide breast services in the United Kingdom. We aimed to assess breast cancer i) local recurrence rate against the national benchmarks of <5% (for invasive cancer) and <10% (for noninvasive cancer) at 5- year, and ii) net survival rates against national record of 95.8% and 85.3%, at 1-year and 5-year, respectively. Methods: All breast cancers (between 01/05/2012 and 30/04/2013) at a district general hospital in the north-west of England were audited. Two general surgeons provided the breast service. One surgeon performed mostly excisional surgery and acted as a 'generalist'. The second surgeon also performed level 2 oncoplastic procedures and acted as an internal control as a 'specialist'. Results: Out of 270 cancers diagnosed, 203 patients underwent surgery. Six patients (out of 180 invasive cancers) developed local recurrences (3.33%). Two patients (out of 23 patients with Ductal Carcinoma-In-Situ) developed local recurrences (8.69%). There was no signicant intersurgeon variation in practice except a difference in the size of the excised lesions. 1-year and 5-year net survival rates amongst all female breast cancer patients were 97% and 87.3%, respectively. Overall survival at 5-year was 79.1%. Conclusions: The results demonstrate that in an unselected cohort of breast cancer patients, general surgeons with interest in breast surgery can achieve acceptable standards in terms of local recurrence at 5-year, and net survivals at 1-year and 5-year. No conceivable difference in practice between two surgeons with 'generalist' and 'specialist' skill-mix was noted. Low overall survival might reect wider health issues. This has implications in planning a local breast service and utilising constrained human resources in the era of specialisation.

Safety of trastuzumab, alone or in combination, in elderly patients with HER2-positive breast cancer: A 5-year case series.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11056-e11056 ◽  
Author(s):  
Vincenzo Adamo ◽  
Giuseppina R. R. Ricciardi ◽  
Barbara Adamo ◽  
Giuseppa Ferraro ◽  
Tindara Franchina ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Case Series ◽  
The Elderly ◽  
Left Ventricular ◽  
Treatment Withdrawal ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Her2 Breast Cancer

e11056 Background: Breast cancer (BC) is frequent in the elderly and is burdened by high recurrence and death rates, due mostly to undertreatment. Trastuzumab (T), in combination with chemotherapy (CT) or hormonotherapy (HT), is a well-established treatment strategy for early and advanced HER2-positive (HER2+) breast cancer, but has been poorly studied in the elderly setting due to its infrequency. The aim of our study is to assess the safety of T in elderly patients with HER2+ BC. Methods: Between 2005 and 2010, consecutive HER2+ breast cancer patients of ≥70 years of age referred to two oncology centers and that received T-based therapy were retrospectively reviewed. All patients were treated according to multidimensional geriatric assessment (MGA) and clinical criteria. Results: Of 59 patients, 51 were evaluable with a mean age of 76 years (range 70-86). Trastuzumab was well tolerated overall. Median left ventricular ejection function (LVEF) at baseline was 61% and at the end of treatment was 55%. The most relevant adverse events consisted of only one case (2%) of symptomatic congestive heart failure, which required treatment withdrawal and six (12%) asymptomatic decreases of LVEF (3 pts >15% and 3 pts >10% versus baseline). Mild to moderate hypersensitivity reactions associated with T-containing infusions occurred in 3 patients (5.8%). Hypertension, obesity and previous anthracycline-based treatment and combination with CTs gave a trend towards a higher incidence of toxic events. Previous radiotherapy, concurrent HT and the different T schedules did not influence toxicity. Conclusions: Our data shows a good trastuzumab safety profile in non-frail women age 70 and older. These favourable findings may be related to the limited number of anthracycline pre-treatments, a substantial patient selection by MGA and close cardiologic monitoring. [Table: see text]

scholarly journals Current Strategies of Endocrine Therapy in Elderly Patients with Breast Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Suk-young Lee ◽  
Jae Hong Seo
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Hormone Therapy ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Hormone Receptors ◽  
Metastatic Breast ◽  
The Elderly ◽  
Breast Cancer Patients ◽  
Equivalent Efficacy

Currently, the growing population of the elderly is one of biggest problems in terms of increase in geriatric diseases. Lack of data from large prospective studies on geriatric breast cancer patients often makes it difficult for clinicians to make treatments decisions for them. Because both benefit and risk of treatment should be taken into account, treatment is usually determined considering life expectancy or comorbidities in elderly patients. Treatment of breast cancer is differentiated according to histologic classifications, and hormone therapy is even adopted for patients with metastatic breast cancer if tumor tissue expresses hormone receptors. Endocrine therapy can offer great benefit to elderly patients considering its equivalent efficacy to chemotherapy with fewer toxicities if it is appropriately used. Aromatase inhibitors are usually prescribed agents in hormone therapy for elderly breast cancer patients due to their physiology after menopause. Here, endocrine therapy for elderly patients with breast cancer in neoadjuvant, adjuvant, and palliative setting is reviewed along with predictive adverse events resulting from the use of hormone agents.

scholarly journals A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer

2013 ◽  
Vol 95 (5) ◽  
pp. 353-356 ◽  
Author(s):  
S Wylie ◽  
D Ravichandran
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Endocrine Therapy ◽  
Elderly Women ◽  
Breast Surgery ◽  
Significant Proportion ◽  
Operable Breast Cancer ◽  
Breast Cancer Patients ◽  
Primary Endocrine Therapy ◽  
The Uk

Introduction A significant proportion of elderly breast cancer patients in the UK have no surgical treatment recorded and appear to be treated with primary endocrine therapy (PET) only. Despite this, PET remains one of the poorly studied areas in breast cancer therapy and very little is known about the practice of PET in the UK. Methods A questionnaire comprising 14 questions relevant to PET was sent to 489 breast surgeons who were members of the UK Association of Breast Surgery and returned questionnaires were analysed. Results Overall, 228 questionnaires (47%) were returned. The vast majority (93%) of surgeons who responded use PET in early operable breast cancer in elderly women unfit for surgery or owing to patient preference but 7% would recommend PET to fit elderly patients. Most (76%) use letrozole. The percentage of elderly patients treated with PET varied from <10% to 70% between surgeons. The majority (77%) of respondents had not formally audited the outcome of their PET patients and over 70% underestimated the expected survival of an 80-year-old woman. Conclusions Most UK breast surgeons use PET in elderly patients with surgically resectable breast cancer. While most use it in unfit, frail patients, a minority would treat even fit elderly women with PET. Most surgeons have not formally audited the outcome of their patients treated with PET and underestimate the expected survival of elderly patients, which might have an impact on their decision to offer PET rather than surgery.

scholarly journals Prognosis according to clinical and pathologic lymph node status in breast cancer patients who underwent sentinel lymph node biopsy alone after neoadjuvant therapy

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251597
Author(s):  
Sae Byul Lee ◽  
Hakyoung Kim ◽  
Jisun Kim ◽  
Il Yong Chung ◽  
Hee Jeong Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Survival Rates ◽  
Lymph Node Biopsy ◽  
Lymph Node Status ◽  
Breast Cancer Patients ◽  
Recurrence Rates ◽  
Node Biopsy ◽  
Node Status

This study aimed to evaluate the prognosis of breast cancer patients who received neoadjuvant chemotherapy and underwent sentinel lymph node biopsy (SLNB) alone as axillary surgery regardless of their clinical and pathological lymph node status. We reviewed the records of 1,795 patients from Asan Medical Center who were diagnosed with stage I–III breast cancer and received neoadjuvant chemotherapy during 2003–2014. We selected 760 patients who underwent SLNB alone as axillary surgery and divided these patients into four groups according to their clinical lymph node (cN) and pathological lymph node (pN) status: cN(-)pN(-) (n = 377), cN(-)pN(+) (n = 33), cN(+)pN(-) (n = 242), and cN(+)pN(+) (n = 108). We then compared axillary lymph node recurrence, locoregional recurrence (LRR), distant metastasis-free survival (DMFS), and overall survival (OS) among the four groups using Kaplan–Meier analysis. We compared prognosis between the cN(-)pN(-) and cN(+)pN(-) groups to determine whether SLNB alone is an adequate treatment modality even in patients with cN positive pathology before neoadjuvant therapy but SLNB-negative pathology after NAC. The 5-year axillary recurrence rates in the cN(-)pN(-) and cN(+)pN(-) groups were 1.4% and 2.9%, respectively, and there was no significant difference between the two groups (p = 0.152). The axillary recurrence and LRR rates were significantly different among the four groups, with the pN-negative groups (cN[–]pN[–], cN[+]pN[–]) showing lower recurrence rates. DMFS and OS were also significantly different among the four groups, with the cN negative groups (cN[–]pN[–], cN[–]pN[+]) showing improved survival rates. Our study findings suggest that SLNB alone was associated with lower LRR rates even in patients with cN positive pathology before neoadjuvant therapy but cN negative pathology after SLNB. Moreover, recurrence and survival rates differ significantly according to clinical and pathological lymph node status.

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