Breast Cancer In Elderly Women Research Articles

Metastatic breast cancer in elderly women: A retrospective cohort study in Morocco.

e13073 Background: Breast cancer (BC) stands as the predominant malignancy among women worldwide, presenting a significant global public health problem. In Morocco, it is the leading cause of cancer-related mortality in females. However, there exists a limited understanding of outcomes and treatment patterns for elderly patients with metastatic breast cancer (MBC) in our context. Methods: We conducted a retrospective cohort study at the Department of Medical Oncology, Hassan II University Hospital of Fez, focusing on 92 female patients aged 65 years or older diagnosed with MBC, between January 2012 and December 2016. The primary objectives were to estimate overall survival (OS) and progression-free survival (PFS), describe treatment patterns, and characterize the clinicopathological, and prognostic aspects of MBC in elderly women in Morocco. Results: The cohort’s median age was 70.88 (range, 65-88years) with 45.6% of patients aged of 65 to 69 years, 34.8% between 70 to 74 years old, and 19.6% over 75. Most patients (77.2%) had an Eastern Cooperative Oncology Group (ECOG) score of 0 to 1, and only 33.7% had comorbidities. De novo stage IV constituted 59.8% of all cases. Metastatic recurrences represent 40.2% with 16.2% having recurrence within 12 months, and 83.8% having a recurrence interval exceeding 12 months. The median time to recurrence was 45.5 months. Invasive ductal carcinoma (IDC) was the predominant histological type (81.1%), with SBR grade II (51%) and grade III (21.7%). Metastases were observed in pleuropulmonary (78.3%), bone (56.5%), lymph nodes (33.7%) and liver (30.4%). With 71.7% having metastases in fewer than three sites, while 28.3% had metastases in three or more sites. Molecular profiling showed Luminal A (38%) and Luminal B (26.1%) subtypes as the most prevalent, followed by triple-negative (17.4%) and HER2+ (15.2%). Treatment modalities included chemotherapy (50%), hormone therapy (15.2%) or a combination of the two (17.4%), and anti-HER2 targeted (14.1%). Median OS was 37 months (95% CI: 16.86 - 57.13 months), and median PFS was 33.16 ± 4.1 months. Anti-HER2 therapy showed a significant association with survival (p = 0,05). Conclusions: This study highlights the characteristics, survival, and treatment modalities of elderly patients with MBC in Morocco. Despite the predominance of luminal BC an intriguing observation was the frequent use of chemotherapy as first line modality.

Abstract PO3-18-02: RISK FACTORS FOR DEATH IN ELDERLY PATIENTS WITH BREAST CANCER TREATED IN AN ONCOLOGY REFERENCE HOSPITAL IN THE CITY OF RECIFE, BRAZIL

Abstract Background: Breast cancer (BC) is the most common type of cancer among women in the world and in Brazil as well. Age is the most important risk factor for the development of cancer. The treatment of BC in elderly women is particularly challenging, as physiological changes, functional deficits, comorbidities and the use of polypharmacy can alter the risk of toxicity. We conducted this trial to determine the risk factors for deaths in less than 180 days after admission in elderly cancer patients with BC treated at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil, and correlate with specific aspects of this type of cancer, such as type of treatment and immunohistochemical profile. Methods: Prospective cohort, in women aged ≥ 60 years, diagnosed with BC, admitted to the IMIP Oncogeriatric Service. At admission, sociodemographic and clinical variables and 10 tests that make up the CGA (Comprehensive Geriatric Assessment) were evaluated, including Mini Nutritional Assessment Short Form (MNA-SF), Polypharmacy and KPS (Karnofsky Performance Status). The follow-up period was at least six months. Descriptive, bivariate analysis using the Fisher and Chi-square tests, a survival study using the Kaplan-Meier method and univariate analysis were performed, including those with p < 0.20 in the multivariate Cox proportional hazards model controlled by Age and Tumor staging. All subjects involved in the research were informed about the objectives of the study and were only included after voluntarily agreeing to participate, signing the informed consent form. Results: The study sample consisted of 326 patients diagnosed with BC in the period from January 2015 to December 2020, all female, with a mean age of 73.46 years (SD ± 7.81). Sociodemographic, clinical and treatment characteristics are described in Table 1. Of the 326 patients, 46 (14,1%) died, and of these, 21 (45,7%) had an infection and 18 (39,1%) required hospitalization. Regarding the domains of the CGA, the characteristics of patients both in the general population and those who died are described in Table 2. After multivariate analysis by Cox regression of clinical variables related to the Comprehensive Geriatric Assessment (CGA) according to death, were identified as a risk factor for death: MNA-SF < 12 (HR = 2,76, IC95%, 1,49-9,48, p =0,001), KPS ≤ 50% (HR = 4,39, IC95%, 2,03-9,48,p < 0,001). Conclusions: In order to improve the efficacy and safety of the treatment of elderly women with BC and to improve their quality of life, the instruments of CGA should be performed routinely. In this population, KPS and Mini Nutritional Assessment Short Version (MNA – SF) were identified as important predictors of early death (180 days after admission). Therefore, in elderly patients with BC who are at risk for malnutrition and have low KPS, the treatment should be analyzed with caution, as well as the evaluation for concomitant early palliative care. Table 1. Sociodemographic, clinical and treatment characteristics of elderly patients treated for BC at IMIP, Recife, 2015-2020. Table 2. Characteristics of CGA (Compreensive Geriatric Assessment) of elderly patients treated for BC at IMIP, Recife, 2015-2020. Citation Format: Ana Cecilia De Vasconcelos, Candice Santos, Jurema Telles, Maria Julia Mello, Bárbara Luz. RISK FACTORS FOR DEATH IN ELDERLY PATIENTS WITH BREAST CANCER TREATED IN AN ONCOLOGY REFERENCE HOSPITAL IN THE CITY OF RECIFE, BRAZIL [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-18-02.

Current Challenges and Perspectives in Breast Cancer in Elderly Women: The Senologic International Society (SIS) Survey

Current Challenges and Perspectives in Breast Cancer in Elderly Women: The Senologic International Society (SIS) Survey

Recurrence Patterns of Breast Cancer in Elderly Women Following Breast Conservation Surgery or Mastectomy without Adjuvant Radiotherapy or Chemotherapy

Recurrence Patterns of Breast Cancer in Elderly Women Following Breast Conservation Surgery or Mastectomy without Adjuvant Radiotherapy or Chemotherapy

Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study

The therapeutic strategy in older adults with breast cancer (BC) has always sought to be a model of personalized medicine. The first example was primary endocrine therapy, a less aggressive treatment targeting a biomarker in a frail patient [ [1] Preece P.E. Wood R.A. Mackie C.R. Cuschieri A. Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J (Clin Res Ed). 1982 Mar 20; 284: 869-870https://doi.org/10.1136/bmj.284.6319.869-a Crossref PubMed Scopus (154) Google Scholar ]. Recently, there have been further proposals to de-escalate surgical procedures, to the extreme of considering omitting surgery altogether [ [2] LeMasters T.J. Madhavan S.S. Sambamoorthi U. Vyas A.M. Disparities in the initial local treatment of older women with early-stage breast Cancer: a population-based study. J Womens Health (Larchmt). 2017 Jul; 26: 735-744https://doi.org/10.1089/jwh.2015.5639 Crossref Scopus (10) Google Scholar , [3] Matar R. Barrio A.V. Sevilimedu V. Le T. Heerdt A. Morrow M. et al. Can we successfully De-escalate axillary surgery in women aged ≥ 70 years with ductal carcinoma in situ or early-stage breast Cancer undergoing mastectomy?. Ann Surg Oncol. 2022 Apr; 29: 2263-2272https://doi.org/10.1245/s10434-021-11140-5 Crossref Scopus (1) Google Scholar ]. However, studies have found a negative impact of omission of surgery on survival and quality-of-life in older patients[ 4 Ward S.E. Richards P.D. Morgan J.L. Holmes G.R. Broggio J.W. Collins K. et al. Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival. Br J Surg. 2018 Oct; 105: 1454-1463https://doi.org/10.1002/bjs.10885 Crossref PubMed Scopus (25) Google Scholar , 5 Wyld L. Reed M.W.R. Morgan J. Collins K. Ward S. Holmes G.R. et al. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer. 2021 Jan; 142: 48-62https://doi.org/10.1016/j.ejca.2020.10.015 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 6 Osório F. Barros A.S. Peleteiro B. Barradas A.R. Urbano J. Fougo J.L. et al. Frailty-independent Undertreatment negative impact on survival in older patients with breast Cancer. J Breast Cancer. 2021 Dec; 24: 542-553https://doi.org/10.4048/jbc.2021.24.e45 Crossref Scopus (1) Google Scholar ].

Imaging in the Diagnosis of Breast Cancer in Elderly Women

The breast cancer diagnosed in the women at or above age 70 is defined as breast cancer in the elderly.As the population keeps aging,breast cancer in the elderly presents increasing incidence and high mortality.Early detection,early diagnosis,and early treatment might improve the prognosis of these patients. Comprehensively evaluating the functional age of elderly patients is essential for the individualized treatment. Medical imaging plays a key role in the screening,early diagnosis,therapy selection,evaluation of neoadjuvant therapy efficacy,and postoperative follow-up.We reviewed the current literature and focused on the role of medical imaging in the diagnosis and treatment recommendations for breast cancer in the elderly.

Interest of individual breast cancer screening by mammography in women aged over 75 years

Retrospective study of a continuous monocentric series of women over 75 having undergone surgery for breast cancer. The following variables were studied: addressing after screening or not, age at diagnosis, UICC stage and therapeutic measures (surgery by lumpectomy or mastectomy, lymph node dissection, adjuvant treatment with chemotherapy, radiotherapy or hormone therapy). 185 women aged 82.8 ± 5.2 years [extreme ages 75 to 95] were included in the study. 136 (73.5%) breast cancers were discovered after palpation and 49 (26.5%) after screening mammography. The distribution by stage was: I - 38.8%, II - 39.5%, III - 15.1% and stage IV - 7%. 164 (87.7%), patients received surgical treatment: 115 lumpectomies (61.2%) and 49 mastectomies (26.5%). 51 (27.6%) patients underwent lymph node dissection. The distribution of adjuvant treatments was: chemotherapy 21.1%, radiotherapy 68.6%, or hormone therapy (79.5%), sometimes combined. Women not screened are older than women screened (84 ± 5.3 versus 79.5 ± 3.6 years; p < 0.0001). Cancers are diagnosed at a more advanced stage in non-screened patients compared to screened patients (p < 0.0001). While there is a higher proportion of stage I among screened patients (75.5%), stage II is the most frequent in women not screened (47%). Stage I and II are the majority in the latter (72%). In multivariate analysis with adjustment for age, screening made it possible to make a diagnosis at a less advanced stage (stage I-II vs II-IV: OR = 5.593; 95% CI [1.575–19.866]; p = 0.0078) and to have conservative surgery more often (lumpectomy vs mastectomy: OR = 2.645; 95% CI [1.079–6.493]; p = 0.0333) without more recourse to surgery (OR = 1.856 95% CI [0.207–16.612]; p = 0.58). After adjusting for age and stage, screening was no longer a determining factor in the choice of type of surgery (OR = 1.934; 95% CI [0.753–4.975]; p = 0.170). At the age when organized breast cancer screening in France stopped, there was a decrease in survival, a diagnosis at a higher stage and an increase in co-morbidities. Our study shows a change in management with heavier treatment, more complications and a greater loss of autonomy without screening. This pleads for a continuation beyond 75 years of the practice of mammography screening for breast cancer in elderly women.

HYPOFRACTIONATEDRADIOTHERAPY OF BREAST CANCER IN ELDERLYWOMEN

Introduction:Breast cancer remains the first malignantpathology in women and itsdiagnosis in elderlywomenislate. The aim of ourworkis to evaluate the effectiveness of hypofractionatedradiotherapy in the treatment of breast cancer in elderlywomen. Material And Methods: This is a retrospectivestudy of 171 patients aged over 65 yearsfollowed for invasive breast cancer and whoreceived adjuvant hypofractionatedradiotherapy at the radiotherapydepartment of CHU Hassan II Fez fromJanuary 2012 to December 2016. Results: The frequency of breast cancer in womenaged over 65 yearswas 7.31%. The averageage of our patients was 70 years (65-88 years) of which 40% wereolderthan 70 years. 8.5% of patients had a familyhistory of breast cancer. The delay of consultation was 10 months. A breast nodule was the revealingsign in all patients withinflammatorysigns in 4.6%axillaryadenopathywasfound in 20% of patients. All cancers werehistologicallyproven. The cancer wasinfiltratingductal in 90% of cases. 27% of the tumorswereScarff-Bloom and Richardson grade I, 45% grade II, 30% grade III. Hormone receptorswereexpressed in 77% and HER positive in 10% of patients. 83% underwentmastectomywithlymphnode dissection followed by adjuvant radiotherapyaccording to the hypo-fractionatedprotocol: total dose of 42Gy on the wall, of which 32% of patients alsoreceivedlymphnode irradiation, fractionation 2.8Gy/Fr in 15 sessions, spread over 19 days 17% of the patients had conservative surgeryassociatedwith adjuvant externalradiotherapy on the breastaccording to the sameschemewith a boost of 11.8Gy on the tumorbed, spread over 25 days.After a medianfollow-up of 5 years, overallsurvivalwasestimated at 84.2%, locoregionalrecurrence-free survival at 84.7% and metastaticrecurrence-free survival at 83%. Acute toxicityconsisted of radiodermatitis in 81% of patients, and post-radiation fibrosis in 15%, and no long-termcardiac or pulmonarytoxicitywasobserved. Conclusion: For elderly patients, adjuvant hypofractionated irradiation seems to be a good alternative, with a good rate of local control, and withoutincreasedtoxicity.

Sleep-disordered breathing and risk of the breast cancer: A meta-analysis of cohort studies.

Sleep-disordered breathing (SDB) has been related to a higher risk of breast cancer whereas the results of previous studies are inconsistent. We, therefore, performed a meta-analysis to evaluate the association between SDB and subsequent risk of breast cancer in women. Cohort studies that investigated the temporal relationship between SDB and breast cancer incidence were obtained via search of PubMed, Embase and Web of Science from inception to 30 January 2021. Only studies with multivariate analyses were included. A fixed or a randomised effect model was applied according to the heterogeneity. Eight cohort studies with 1398113 women were included. Pooled results with a randomised-effect model showed that compared with women without SDB at baseline, women with SDB had a significantly increased risk of breast cancer (risk ratio [RR]: 1.36, 95% confidence interval [CI]: 1.08 to 1.71, P=.01) with significant heterogeneity (P for Cochrane's Q test<.001, I2 =95%). Subgroup analyses showed that SDB seemed to confer a more remarkably increased risk of breast cancer in elderly women (RR: 3.00, 95% CI: 1.33 to 6.76, P=.008) than that in non-elderly women (RR: 1.15, 95% CI: 1.02 to 1.29, P=.02; P for subgroup difference=.04). However, the association was not significantly affected by country of the study, study design, diagnostic strategy for SDB or adjustment of obesity (P for subgroup analyses all>.05). SDB may be an independent risk factor for breast cancer in women, particularly in elderly females.

245P Palbociclib combined with aromatase inhibitors (AIs) in women ≥75 years with oestrogen receptor positive (ER+ve), human epidermal growth factor receptor 2 negative (HER2-ve) advanced breast cancer: A real-world multicentre UK study

Breast cancer accounts for 21% of all cancer diagnoses in women aged ≥75 years. The older population is under-represented in clinical trials; thus, real-world data in this patient group is critical to guide management. In this large-scale UK-wide real-world study, we evaluated the tolerability and efficacy of palbociclib combined with an AI for first-line treatment of advanced ER+ve/HER2-ve breast cancer in elderly women.

Intraoperative Radiotherapy for Breast Cancer in Elderly Women

PurposeTo evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. PopulationWomen older than 65 years, with infiltrating ductal breast cancer ≤3 cm, expressing estrogen receptor (ER+) without Her2 overexpression, and with negative axillary nodes. TreatmentTreatment consisted of partial mastectomy with a sentinel lymph node biopsy (SLNB) procedure; in case of positive SLNB, IORT was cancelled. IORT consisted in a total dose of 20 Gy in 1 fraction delivered at the surface of the applicator with the Intrabeam® technique. ResultsIORT was planned to be administered to a total of 225 patients but was cancelled for 34 patients during surgery. Thus 191 patients were analyzed; mean age was 76 years, with 57 patients (30%) >80 years. Despite inclusion criteria, 15 had lobular carcinoma and 7 were triple negative. With a median follow-up of 40 months, we observed only 1 local recurrence, located in the skin over the initial tumor. The 5-year local relapse rate was 1.7%. A wound healing delay (>15 days) was observed in 21 patients (11%). Sixty-six patients (35%) had postoperative complications, mainly grade 2, resolving within a few days. Two patients needed surgical drainage for local abscesses. Long-term (>1 year) cosmetic outcome was evaluated in 120 patients and was judged excellent or good in 102 (91%). ConclusionIORT can be safely given to elderly women, with a good local control rate and without major toxicities.

Clinical Features of Breast Cancer in Elderly Women

Clinical Features of Breast Cancer in Elderly Women

Differences in clinicopathologic features and subtype distribution of invasive breast cancer between elderly and non-elderly women.

This study aimed to investigate the clinicopathologic features and subtype distribution of invasive breast cancer in elderly women (≥70 years of age). This retrospective study of 1,130 women compared the clinicopathologic characteristics and subtype distribution of invasive breast cancer in elderly (≥70 years) versus non-elderly (<70 years) women. Tumors were classified into five distinct subtypes based on the immunohistochemistry status of estrogen receptor (ER), progesterone receptor (PR), Ki67, and human epidermal growth factor receptor 2 (HER2). The two patient groups did not differ significantly regarding ER and HER2 status. Breast cancers in elderly women were more likely to have negative PR status (40.4% vs. 32.6%, P=0.033) and low Ki67 expression (62.0% vs. 54.4%, P=0.047) than those in non-elderly women. Elderly women were less likely to undergo axillary lymph node dissection and axillary surgery (P<0.001). Consequently, unknown node status was more common in elderly women than non-elderly women (11.1% vs. 1.4%, respectively, P<0.001), while node involvement was less common in elderly women than non-elderly women (26.9% vs. 37.7%, respectively, P<0.001). There was no significant difference in the distribution of subtypes between the two groups. Breast cancers in elderly women were less frequently node positive and more frequently PR negative and with low Ki67 expression than those in non-elderly women. Moreover, there was no difference in subtype distribution between the two age groups.

Survival Outcomes of Early-Stage Hormone Receptor-Positive Breast Cancer in Elderly Women.

Elderly women (≥ 70years old) form a significant proportion of patients affected by breast cancer (BC); however, the treatment decisions for this patient population are complicated, owing to the presence of comorbidities, limited life expectancy, reduced tolerability of therapy, and limited enrollment in clinical trials. A growing body of evidence suggests equivalent outcomes in elderly patients with hormone receptor-positive early-stage breast cancer receiving primary endocrine therapy only or surgery with subsequent endocrine therapy. Whether these results are reproduced in the larger BC population outside of a clinical trial currently remains unclear. Women ≥ 70years old diagnosed with early-stage invasive breast cancer between January 2008 and December 2013 with tumor size T1 or T2, minimal nodal involvement (N0 and N1), and estrogen and/or progesterone receptor positivity who started endocrine therapy within a year of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked datasets. Endocrine therapy was identified using outpatient prescription fills for anastrozole, exemestane, fulvestrant, letrozole, raloxifene, tamoxifen, and toremifene; the first fill date was used as the treatment initiation date. Surgical intervention included either breast-conserving surgery or mastectomy. Women who received chemotherapy were excluded. Trends in the use of primary endocrine therapy only were assessed using Poisson regression. Multivariable Cox proportional hazard regression was used to estimate the association between undergoing surgery within a year of diagnosis and 5-year all-cause mortality, after adjusting for patient demographics, comorbidities, and clinical cancer characteristics. Similar methods were used to assess 5-year cancer-specific mortality, where noncancer mortality was treated as a competing risk. Overall, 8784 women were included in the analysis: 8006 (91%) received surgery with endocrine therapy and 778 (9%) received primary endocrine therapy alone. The proportion of women not receiving surgery remained consistent between 2008 and 2013 (p = 0.10). The 5-year mortality was 11% (n = 619), and 19% of all deaths were due to cancer causes (n = 117). After adjustment, 5-year mortality was lower among women undergoing surgery (HR 0.59, 95% CI 0.47-0.74, p < 0.0001). Similar results were found when looking at 5-year cancer-specific mortality (HR 0.52, 95% CI 0.30-0.90, p < 0.0001). Elderly breast cancer patients with early-stage hormone-receptor-positive disease receiving primary surgical intervention plus endocrine therapy may have significantly improved survival than those receiving primary endocrine therapy alone. This study suggests the importance of surgical intervention for elderly breast cancer patients and warrants further investigation and comprehensive geriatric assessment to identify subsets of elderly breast cancer patients who may benefit significantly from surgical intervention.

Trends in Surgical Axillary Management in Early Stage Breast Cancer in Elderly Women: Continued Over-Treatment.

In the past two decades, three prospective randomized trials demonstrated that elderly women with early stage hormone positive breast cancer had equivalent disease-specific mortality regardless of axillary surgery. In 2016, the Choosing Wisely campaign encouraged patients and providers to reconsider the role of axillary surgery in this population. We sought to identify factors that contribute to adopting non-operative management of the axilla in these patients. We performed a retrospective analysis of women ≥ 70years old with cT1/T2, hormone positive invasive ductal carcinoma who underwent partial or total mastectomy, with/without axillary surgery, and did not receive adjuvant chemotherapy from the National Cancer Database from 2004 to 2015. We used multivariable log-binomial regression to model the risk of undergoing axillary surgery across region, care setting, and Charlson-Deyo scores, and analyzed temporal trends using Poisson regression. From 2004 to 2015, 87,342 of 99,940 women who met inclusion criteria (83%) had axillary surgery. Over time, axillary surgery increased from 78% to 88% (p < 0.001). This rise was consistent across region (p = 0.81) and care setting (p = 0.09), but flattened as age increased (p < 0.001). Omitting axillary surgery was more likely in patients treated in New England (RR 0.88, 95% CI 0.86, 0.89) and patients ≥ 85 (RR 0.66, 95% CI 0.65, 0.67). Axillary surgery continues to be the preferred option of axillary management in elderly women with early stage, clinically node negative, hormone-positive, invasive breast cancer despite no survival benefit. Identifying factors to improve patient selection and dissemination of current recommendations can improve adoption of current evidence on axillary surgery in the elderly.

Breast Cancer in Elderly Women: Role of Tumor Characteristics in Predicting Axillary Lymph Node Metastasis

Background: The number of elderly women with breast cancer is increasing and becoming a major health concern. Worldwide. Nearly a third of breast cancer cases occurs in eldery women. Differences in the pathologic features of breast tumors in aging women have been described. Axillary lymph node metastasis (ALNM) is one of the most important prognostic factors in breast cancer patients. Some studies reported that tumor characteristics were related to an increased axillary lymph node metastasis. The aim of this study was to identify tumor characteristics associated with axillary lymph node metastasis.

Stereotactic radiation therapy for breast cancer in the elderly.

The management of breast cancer in elderly women is going to be a major public health issue in a near future. The use of hypofractionated stereotactic radiotherapy is expanding but might be a priori not offered to older patients. We addressed the role of stereotactic radiotherapy (SBRT, 1–10 fractions) in elderly patients with breast cancer, in definitive, adjuvant and metastatic settings. Review of the literature. Of six series using SBRT for partial breast or breast boost irradiation and over 20 oligometastatic (brain, lung, liver, bone) SBRT series including patients aged ≥60 years old, no difference was found in term of efficacy (>80%) and toxicity (<5% G3-4) compared to the younger. Hypofractionation is also well adapted to the elderly, due to limited transportation-related fatigue. SBRT studies by age group are lacking. However, hypofractionated SBRT is particularly adapted to older patients with breast cancer, in term of efficacy and tolerability and should be encouraged rather than more morbid treatments whenever possible.

Adjuvant radiotherapy for low-risk early breast cancer in elderly women: evidence from randomized trials.

Breast cancer is the most common cancer pathology in women in the Western world. The median age at diagnosis is 60 years and in the coming decades it is estimated that the number of elderly women affected reaches an important percentage. This aging of the cancer population, associated with its inherent comorbidities and aggravated by the lack of consensus about the most appropriate treatment, make it difficult to administer an effective postoperative treatment in elderly women with a low-risk profile. An exhaustive geriatric evaluation is a sine qua non condition to opt for a specific type of treatment. To date, several options are available such as endocrine therapy (ET) alone, moderate/high hypofractionation and various accelerated partial breast irradiation (APBI) techniques. In this article, we provide information about each of them.

Lumpectomy plus Endocrine Therapy or Irradiation in Women Age 70 Years or Older with Hormone Receptor-Positive Early Breast Cancer: An Analysis of the National Cancer Database

Interest exists for de-intensification of adjuvant therapy in the treatment of early stage, biologically favorable breast cancer in elderly women. CALGB C9343 examined women ≥70 years (ER+, stage I) treated by lumpectomy followed by either adjuvant endocrine therapy (ET) + radiation therapy (RT), or ET alone with a median follow up of 12.6 years. They found no difference in survival (OS) between the groups. PRIME II evaluated women ≥65 years (ER/PR+, T1-2N0) treated with lumpectomy followed by either adjuvant ET or ET+RT with a median follow up of 5 years. They found no differences in overall survival outcomes. Both studies concluded that consideration could be given for omission of RT in this setting. However, toxicity from ET is not trivial and adherence rates range from 40-90%. We hypothesize that de-escalation with use of RT and omission of ET would have comparable survival outcomes in healthy elderly women with early stage breast cancer. Patients ≥70 years of age with a Charlson/Deyo (CD) score 0-1 in the National Cancer Database (2010-2014), with T1N0 hormone receptor positive, HER-2 negative breast cancer, who were treated with lumpectomy and either adjuvant ET alone or adjuvant RT alone, were identified. To reduce the impact of treatment selection bias, propensity scores were used to match patients based on age, CD score, education, income, and geographical location. OS was measured from the time of diagnosis to the time of death and was estimated using the Kaplan-Meier method and compared using stratified log-rank test. A total of 2,995 patients, with a median age of 78 years (range 70-90), met inclusion criteria. The majority of patients had CD score 0 (81%), white ethnicity (91%), clinical stage IA disease (77%), and were ER/PR+ (100%/91%). Of these, 65% (n=1,957) were treated with adjuvant ET alone and 35% (n=1,038) were treated with adjuvant RT alone, following lumpectomy. On multivariate analysis of the matched cohort, older age (HR 1.10, p<0.001) and a CD score of 1 (HR 1.92, p=0.0002) predicted for worse survival; living in an Urban area compared to a metropolitan area portended for improved survival (HR 0.32, p=0.004). Income level and education level did not predict for survival. The median follow up time for all patients was 45 months and the 5-year OS rate in the matched cohort was 85% in both groups. There was no difference in OS between patients treated with adjuvant ET or RT (p=0.41). Healthy (CD 0-1) older patients with hormone receptor positive, HER-2 negative breast cancer treated with lumpectomy followed by either adjuvant RT or ET have equivalent 5 year survival outcomes. Given the relatively high rates of non-compliance with adjuvant ET, a randomized controlled trial to confirm the favorable outcomes we report with either adjuvant RT or adjuvant ET is warranted.

Abstract P1-17-06: Breast cancer in elderly women: Ageism or primum non nocere?

Abstract Background: The risk of breast cancer increases with advancing age. Routine use of screening mammogram in women after 75yrs and its impact on overall survival is controversial. Studies have also found that elderly breast cancer patients are underrepresented among clinical trials and a tendency for undertreatment may result in inferior outcome. Method and Material:Female patients with breast cancer who were 75 years or older and diagnosed from 2000-2015 were identified from Surveillance, Epidemiology, and End Results (SEER) 18 database. We excluded patients with unknown stage and race. We performed multivariate and survival analysis using JMP pro 13. Results: 186,682 women with breast cancer of ≥ 75 yrs. were identified from the SEER. 167,802 patients met the inclusion criteria. Mean age was 81.27 years (CI 95% 81.25-81.30). Most of the patients were white (88%), and had Stage I/II (83%) breast cancer.78% of patients had estrogen receptor positive cancer, while 66% had grade 1/2 disease. The 5-year overall survival was 74% for Stage I,60% for Stage II,38% for stage III and 11% for Stage IV cancer(p&amp;lt;0.0001). The disease specific survival (DSS)for stage I (96%), Stage II (88%), Stage III (64%), and Stage IV (23%).Out of the patients who were deceased at the time of analysis only 24% of deaths were attributed to this cancer. Cox proportional hazards regression model of overall survival [Table:1] Cox proportional hazards regression model of overall survivalVariableHazard ratio( 95% CI)p value75—79 80-84 85+1 1.22 1.7&amp;lt;0.0001Race White Black Others1 1.14 0.95&amp;lt;0.001ER Positive Negative unknown1 1.19 1.2&amp;lt;0.001Stage I Stage II Stage III Stage IV1 1.17 1.66 3.7&amp;lt;0.001 Conclusion: Early breast cancer continues to be the most common presentation for patients ≥75 yrs. of age. Historical prognostic factors of breast cancer like race, hormone receptor status, stage and grade continue to impact cancer outcome among elderly patients. Only 24% of deaths among the deceased were attributed to this breast cancer highlighting the concern for over diagnosis. Nonetheless once diagnoses is established a multidisciplinary comprehensive geriatric assessment should be the cornerstone of the management. Citation Format: Muzaffar M, Vohra N, Wong J. Breast cancer in elderly women: Ageism or primum non nocere? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-06.