scholarly journals NCCN Task Force Report: Breast Cancer in the Older Woman

2008 ◽  
Vol 6 (S4) ◽  
pp. S-1-S-25 ◽  
Author(s):  
Robert W. Carlson ◽  
Susan Moench ◽  
Arti Hurria ◽  
Lodovico Balducci ◽  
Harold J. Burstein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Older Patients ◽  
Randomized Clinical Trials ◽  
Task Force ◽  
Locally Advanced ◽  
Geriatric Oncology ◽  
Assessment Tools ◽  
Older Woman ◽  
Task Force Report

Breast cancer is common in older women, and the segment of the U.S. population aged 65 years and older is growing rapidly. Consequently, awareness is increasing of the need to identify breast cancer treatment recommendations to assure optimal, individualized treatment of older women with breast cancer. However, the development of these recommendations is limited by the heterogeneous nature of this population with respect to functional status, social support, life expectancy, and the presence of comorbidities, and by the underrepresentation of older patients with breast cancer in randomized clinical trials. The NCCN Breast Cancer in the Older Woman Task Force was convened to provide a forum for framing relevant questions on topics that impact older women with early-stage, locally advanced, and metastatic breast cancer. The task force is a multidisciplinary panel of 18 experts in breast cancer representing medical oncology, radiation oncology, surgical oncology, geriatric oncology, geriatrics, plastic surgery, and patient advocacy. All task force members were from NCCN institutions and were identified and invited solely by NCCN. Members were charged with identifying evidence relevant to their specific expertise. During a 2-day meeting, individual members provided didactic presentations; these presentations were followed by extensive discussions during which areas of consensus and controversy were identified on topics such as defining the “older” breast cancer patient; geriatric assessment tools in the oncology setting; attitudes of older patients with breast cancer and their physicians; tumor biology in older versus younger women with breast cancer; implementation of specific interventions in older patients with breast cancer, such as curative surgery, surgical axillary staging, radiation therapy, reconstructive surgery, endocrine therapy, chemotherapy, HER2-directed therapy, and supportive therapies; and areas requiring future studies. (JNCCN 2008;6[Suppl 4]:S1–S25)

Breast cancer in older women.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1132-1132
Author(s):  
David B. Pearlstone ◽  
Tyler Stewart ◽  
Ashkan Afshari ◽  
Lyly Nguyen ◽  
Rosemary Garofalo
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Older Women ◽  
Older Patients ◽  
Locally Advanced ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Node Positive ◽  
Disease Free

1132 Background: Recent guidelines recommend minimizing breast cancer screening for women over the age of 75. This study examines the presentation and outcome of older patients with breast cancer to determine if increasing screening among older patients may result in better outcomes. Methods: A prospective database at Hackensack University Medical Center was queried for all patients with breast cancer diagnosed between 1/1/2006 and 1/1/2011. Numerical values compared by Student’s t -test; categorical values by Fisher exact test. Median time to events determined by Kaplan-Meier; outcomes compared by log-rank test. Results: 2200 patients were identified (> 75 years, n=335, < 75 years, n=1865). Among the older cohort, mean age was 81 +/- 4 years (range: 75 – 101); mean tumor size was 2.3 +/- 0.1 cm (range: .1 – 12). Most tumors were invasive and localized (in-situ: 12.7%, localized: 57.3%, node positive: 24.0%, metastatic: 5.8%) and most commonly ductal histology (ductal: 77.0%; lobular: 16.6%, mixed:6.2%). Only 10.0% of patients with invasive disease and 29.2% with positive nodes received systemic therapy; 90.2% underwent surgical resection. Disease-free and overall 5 year survival was 54.9% and 62.9% (in-situ: 82.2%; localized: 67.1%; node positive: 57%; metastatic 22%). Older patients had larger tumors (2.30 +/- .11 v. 1.91 +/- .04 cm; p<0.001), more locally advanced (T4) disease (6.7% v. 1.7%, p<.001), more invasive disease (89% v. 84%, p<.01). Older patients had less positive family history (21.7% v. 37.3%, p<.0001). There was no difference between the groups in race, presentation with stage IV disease, tumor grade, lymphovascular invasion, histologic subtype, triple negativity, or nodal positivity. Overall and disease free five year survival were significantly worse for older patients (OS: 90.2% v. 63.9%, p< .0001; DFS: 80.9% v. 54.9%, p<.0001). Conclusions: Breast cancer among older women leads to worse outcomes compared to younger patients, regardless of histology, invasiveness of disease, hormonal status, nodal status or tumor grade. Older women present with more invasive disease, larger tumors and more locally advanced disease, despite having less family history. This implies that continued screening beyond age 75 may lead to less advanced presentation and better outcomes.

Impact of dose intensity chemotherapy, in geriatric population with locally advanced breast cancer treated in neoadjuvant setting at the National Cancer Institute, Mexico City.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 134-134
Author(s):  
H. C. Arce Salinas ◽  
R. Ramirez-Morales ◽  
C. Aguila ◽  
A. Alvarado Miranda ◽  
J. Santamaria-Galicia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Older Patients ◽  
Locally Advanced ◽  
Dose Intensity ◽  
Her2 Status ◽  
Combination Regimen ◽  
Toxicity Profile ◽  
Surgical Specimen ◽  
Younger Patients

134 Background: Breast cancer in older women has a tendency to increase its incidence; the prevalence and their clinical course are not reported. This group of patients is usually considered to be fragile; they receive dose levels of chemotherapy below standards. Objective: To compare the association of dose intensity with complete pathological response (cPR) in older women. Methods: This is a retrospective analysis of patients treated with neoadjuvant anthracyclines, taxanes, or combination regimen from 2005 to 2008. Pathologic response was evaluated in the surgical specimen. Results: We analyzed 801 cases, 694 (86.6%) patients were younger than 65 years-old and 107 (13.3%) were older than 65 years-old. Clinical stage, histological type and HER2 status were similar in both groups. High-grade lesions were more common in the younger group (61% vs. 41% p>0.05). ER+/PR+ were more frequent for the group >65 years-old (57.5/47% vs. 79.5/50%) p=NS. Triple-negative were 154 cases (22%) for younger patients and 14 cases (13%) for elderly women (p=0.02). Optimal dose intensity was above 80% of planned dose. For anthracycline-based regimen, older patients had more dose reduction (27.8%) in comparison to the younger group 2.1% (p= 0.00001), for the taxane regimen dose intensity was less than the standard in 8.8% of young population vs. 17.6% for older women (p = 0.03). The rate of cPR in younger patients was 20.3% vs. 11.1% in the older group (p<0.001). Toxicity profile was statistically similar in both groups. Conclusions: Breast cancer has the same presentation in younger and in older patients. Older patients receive less dose intense chemotherapy. This is associated with a lesser rate of cPR. Therefore, older patient should be treated with full doses taking into account the toxicity profile of the chemotherapeutic regimens as well as the physical and medical conditions of the patient.

scholarly journals NCCN Task Force Report: Estrogen Receptor and Progesterone Receptor Testing in Breast Cancer by Immunohistochemistry

2009 ◽  
Vol 7 (Suppl_6) ◽  
pp. S-1-S-21 ◽  
Author(s):  
D. Craig Allred ◽  
Robert W. Carlson ◽  
Donald A. Berry ◽  
Harold J. Burstein ◽  
Stephen B. Edge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Progesterone Receptor ◽  
Invasive Breast Cancer ◽  
Hormone Receptors ◽  
Ductal Carcinoma ◽  
Task Force ◽  
Strong Predictor ◽  
Surgical Oncology ◽  
Task Force Report

The NCCN Task Force on Estrogen Receptor and Progesterone Receptor Testing in Breast Cancer by Immunohistochemistry was convened to critically evaluate the extent to which the presence of the estrogen receptor (ER) and progesterone receptor (PgR) biomarkers in breast cancer serve as prognostic and predictive factors in the adjuvant and metastatic settings, and the ability of immunohistochemical (IHC) detection of ER and PgR to provide an accurate assessment of the expression of these biomarkers in breast cancer tumor tissue. The task force is a multidisciplinary panel of 13 experts in breast cancer who are affiliated with NCCN member institutions and represent the disciplines of pathology, medical oncology, radiation oncology, surgical oncology, and biostatistics. The main overall conclusions of the task force are ER is a strong predictor of response to endocrine therapy; ER status of all samples of invasive breast cancer or ductal carcinoma in situ (DCIS) should be evaluated by IHC; IHC measurements of PgR, although not as important clinically as ER, can provide useful information and should also be performed on all samples of invasive breast cancer or DCIS; IHC is the main testing strategy for evaluating ER and PgR in breast cancer and priority should be given to improve the quality of IHC testing methodologies; all laboratories performing IHC assays of ER and PgR should undertake formal validation studies to show both technical and clinical validation of the assay in use; and all laboratories performing IHC assays of hormone receptors in breast cancer should follow additional quality control and assurance measures as outlined in the upcoming guidelines from the American Society of Clinical Oncology and College of American Pathologists.

scholarly journals Use of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in older patients with ER-positive HER2-negative breast cancer: Young International Society of Geriatric Oncology review paper

2018 ◽  
Vol 10 ◽  
pp. 175883591880961 ◽  
Author(s):  
Nicolò Matteo Luca Battisti ◽  
Nienke De Glas ◽  
Mina S. Sedrak ◽  
Kah Poh Loh ◽  
Gabor Liposits ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Older Patients ◽  
Geriatric Oncology ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Cyclin Dependent Kinase ◽  
Current Standard ◽  
Oncology Review ◽  
Er Positive

The current standard of care for the management of estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer has been redefined by the introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Although adults aged 65 years and older account for the majority of patients with breast cancer, limited data are available about the age-specific dosing, tolerability, and benefit of CDK4/6 inhibitors in this growing population. Older adults are under-represented in clinical trials and as a result, clinicians are forced to extrapolate from findings in younger and healthier patients when making treatment decisions for older patients. In this article, we review the limited age-specific evidence on the efficacy, toxicity, and quality of life (QoL) outcomes associated with the use of CDK4/6 inhibitors in older adults. We also describe ongoing trials evaluating CDK4/6 inhibitors in the older population and highlight that only a minority of adjuvant and metastatic trials of CDK4/6 inhibitors in the general breast cancer population includes geriatric assessments. Finally, we propose potential strategies to help guide decision making for fit and unfit older patients based on disease endocrine sensitivity, the need for rapid response and geriatric assessment.

scholarly journals Cytoplasmic Cyclin E Is an Independent Marker of Aggressive Tumor Biology and Breast Cancer-Specific Mortality in Women over 70 Years of Age

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 712 ◽  
Author(s):  
Simon J. Johnston ◽  
Binafsha M. Syed ◽  
Ruth M. Parks ◽  
Cíntia J. Monteiro ◽  
Joseph A. Caruso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Older Patients ◽  
Cyclin E ◽  
Cohort Analysis ◽  
Tumor Biology ◽  
Biological Factor ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Aggressive Tumor

Multi-cohort analysis demonstrated that cytoplasmic cyclin E expression in primary breast tumors predicts aggressive disease. However, compared to their younger counterparts, older patients have favorable tumor biology and are less likely to die of breast cancer. Biomarkers therefore require interpretation in this specific context. Here, we assess data on cytoplasmic cyclin E from a UK cohort of older women alongside a panel of >20 biomarkers. Between 1973 and 2010, 813 women ≥70 years of age underwent initial surgery for early breast cancer, from which a tissue microarray was constructed (n = 517). Biomarker expression was assessed by immunohistochemistry. Multivariate analysis of breast cancer-specific survival was performed using Cox’s proportional hazards. We found that cytoplasmic cyclin E was the only biological factor independently predictive of breast cancer-specific survival in this cohort of older women (hazard ratio (HR) = 6.23, 95% confidence interval (CI) = 1.93–20.14; p = 0.002). At ten years, 42% of older patients with cytoplasmic cyclin E-positive tumors had died of breast cancer versus 8% of negative cases (p < 0.0005). We conclude that cytoplasmic cyclin E is an exquisite marker of aggressive tumor biology in older women. Patients with cytoplasmic cyclin E-negative tumors are unlikely to die of breast cancer. These data have the potential to influence treatment strategy in older patients.

Influence of geriatric oncology consultation on the management of breast cancer in older women: A French population-based study

2014 ◽  
Vol 15 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Sophie Somana-Ehrminger ◽  
Tienhan S Dabakuyo ◽  
Patrick Manckoundia ◽  
Samiratou Ouédraogo ◽  
Sophie Marilier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Geriatric Oncology ◽  
Population Based ◽  
French Population ◽  
Population Based Study

scholarly journals Frailty and Adherence to Adjuvant Hormonal Therapy in Older Women With Breast Cancer: CALGB Protocol 369901

2014 ◽  
Vol 32 (22) ◽  
pp. 2318-2327 ◽  
Author(s):  
Vanessa B. Sheppard ◽  
Leigh Anne Faul ◽  
George Luta ◽  
Jonathan D. Clapp ◽  
Rachel L. Yung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Hormonal Therapy ◽  
Older Patients ◽  
Proportional Hazards ◽  
Self Report ◽  
Covariate Adjustment ◽  
Adjuvant Hormonal Therapy ◽  
Estrogen Receptor Positive ◽  
Major Predictor

Purpose Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation. Patients and Methods A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor–positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively. Results Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003). Conclusion Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.

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.

Relationship of pathological features and a 21 gene expression assay in young women with early breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12050-e12050
Author(s):  
Martin Boniface Gitobu Mutonga ◽  
Sedona Speedy ◽  
Regina Uthe ◽  
Kelly Kindy ◽  
Aisha Brownlee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Older Women ◽  
Older Patients ◽  
Recurrence Score ◽  
Pathological Feature ◽  
Pathological Features ◽  
Gene Expression Assay ◽  
Gene Assay

e12050 Background: There is emerging evidence that a 21 gene expression assay recurrence score (RS) is prognostic independent of age. In practice, pathological markers may influence decision to recommend adjuvant chemotherapy. Methods: The primary objective of this study is to investigate the relationship between the RS and pathological markers between younger (29-49) and older (50-79) women with early stage ER+ breast cancer. Pathological markers investigated included the progesterone receptor (PR), grade, Ki-67, and P53. Patients who underwent 21 gene assay testing between 2002 through 2012 were sequantially identified. Data was extracted via the institutional tumor registry or chart reviewing. For each pathological feature, mean RS was compared between younger and older patients by t-tests. Trends in chemotherapy recommendation were assessed between younger and older patients within each RS risk category (≤10, 11-25, ≥26). Results: Between 2002 and 2012, 344 eligible patients were identified. 133 were ≤49 years of age, and 211 ≥50. There was no difference in distribution of RS across age (R2=3x10-4). Between younger and older patients, there was no difference in mean RS for any pathological marker (table 1). Within each age group, mean RS was always higher in tumors that were PR negative, grade 2/3, Ki67 >10%, and P53 ≥10% (p<0.05, respectively). In patients with a RS ≤10, 0% were recommended adjuvant chemotherapy irrespective of age. In patients with a RS 11-25, 39% of younger and 40% of older women were recommended chemotherapy. In patients with a RS ≥26, 100% of younger and 98% of older women were recommended chemotherapy. Conclusions: The relationships between pathological features and RS are consistent across age, supporting observations that the RS can predict benefit irrespective of age. See table. [Table: see text]

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