Cancer In Elderly Women Research Articles

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.

Outcomes of robotic surgery for endometrial cancer in elderly women

IntroductionFew data have been reported on robot-assisted surgery in elderly. The objectives were to compare feasibility, complication data, and survival of patients under and upper the age of 70 who are managed for endometrial cancer by robot-assisted laparoscopy. Materials and methodsThis is a retrospective comparative single-center study including patients treated between January 2007 and December 2016. Patients were divided into 2 groups: less than 70 years and greater than or equal to 70 years. The primary endpoint was the rate of complications. The secondary endpoints were conversion rate and follow-up. Results148 patients were included: 86 under 70 (group A) and 62 aged 70 and over (group B). More adhesiolysis was performed in group B (p < .01); the pelvic and para-aortic lymph node dissection rates were not different between both groups (p = .2 and p = .9). The operating times were significantly longer in group B (220.1 vs. 234.4 min, p = .02). The conversion rate was similar between the 2 groups (p = .7). The tumors were endometrioid adenocarcinomas for 77.9 and 66.7% respectively (p = .2), with grade 3 tumors more represented in older patients (24.4% vs. 48.4%, p < .01). There were more tumors at high risk of recurrence after 70 years (33.7 vs. 45.2%, p = .04). No significant difference was found for postoperative complications. There was no difference in overall survival (p = .7) or progression-free survival (p = .2). Undertreated women rate was similar in both groups (p = .1). ConclusionRobotic surgery appears feasible and reproducible and could bring a benefit and allow optimal surgery without increasing the morbidity in the management of endometrial cancers whatever the age is.

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.

Diagnostic value of serum tumor biomarkers for endometrial cancer in elderly women with intrauterine abnormalities on transvaginal ultrasound

Objective To investigate age-related changes in serum tumor markers carbohydrate antigen 125(CA125), CA153 and CA199, and the clinical significance of separate and combined detection of these markers for screening endometrial carcinoma(EC)in elderly women with intrauterine abnormalities on transvaginal ultrasound(TVS). Methods Cross-sectional data of 420 elderly women suspected of having an intrauterine abnormality by TVS and undergone hysteroscopy with dilation and curettage from January 2010 to December 2017 were retrospectively analyzed.Patients were divided into a 60-64 years-old group and a 65-83 years-old group.Aging-related changes in positive rates of CA125, CA153 and CA199 were compared between the two groups.Differences in positive rates of tumor markers were compared between different pathological types.Using postoperative pathological diagnosis as the gold standard for EC, the diagnostic sensitivity, specificity and accuracy of serum CA125, CA153 and CA199 alone or in combination for EC were calculated. Results The positive rates of CA125, CA153 and CA199 were 3.9%(16/412), 0%(0/172)and 5.0%(20/404), respectively.The positive rate of CA125 was higher in the 65-83 years-old group(6.5%, 16/246)than in the 60-64 years-old group(0.0%, 0/166)(P=0.001). The positive rates of CA125 and CA199 in patients with EC were 14.3%(4/28)and 42.9%(12/28), which were higher than those in patients with other pathological types.However, the sensitivity of single and combined detection of CA125 and CA199 was too low for the diagnosis of EC(14%、43%). Conclusions The single and combined detection of CA125, CA153 and CA199 for screening EC is of limited value in elderly women.New tumor markers need to be identified and used in combination with TVS for screening EC in elderly women. Key words: Endometrial neoplasms; Transvaginal sonography; Tumor biomarker

Analysis of cervical cancer screening results in women aged 50 and older in Beijing and Guizhou

Objective: To analyze the screening results of cervical cancer in elderly women in Beijing and Guizhou. To compare the screening effectiveness of cervical cancer in elderly women in different areas. Methods: A retrospective analysis was performed on the screening data of elderly women (≥50 years) who had examination at cervical lesion clinic in Peking University People's Hospital and Affiliated Hospital of Guizhou Medical University from January 2013 to January 2014, with histopathology as the gold standard, to compare screening effectiveness of cervical cytology or HPV detection for elderly women in cervical cancer screening in the two regions. Results: Among the patients with cervical intraepithelial neoplasia grade 2 and above (CIN2 + ) detected by colposcopy in Peking University People's Hospital and Affiliated Hospital of Guizhou Medical University, 44.1% (82/186) and 57.0% (98/172) were women aged 50 and older. In Beijing group 39.0% (32/82) of CIN2 + patients had clinical symptoms, which in Guizhou group was 31.6% (31/98). In Beijing group and Guizhou group, 50.0% (19/38) and 73.2% (30/41) patients with cervical cancer had never been screened, respectively. In Beijing group and Guizhou group, 5.4% (4/74) and 19.2% (10/52) of the patients with CIN2 + had cervical cytology negative for intraepithelial lesion or malignancy (NILM), respectively (P=0.015). The cervical cytology showed atypical squamous cells of undetermined significance (ASC-US) in 10.2% (13/127) and 24.6% (14/57), respectively, with significant difference (P=0.01). The cervical cytology showed low-grade squamous intraepithelial lesions (LSIL) in 14.9% (11/74) and 37.5% (6/16) with no significant difference (P=0.08). Atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) were 41.7% (5/12) and 71.4% (20/28) with no statistically significant difference (P=0.15). High-grade squamous intraepithelial lesions (HSIL) were 78.9% (15/19) and 86.4% (19/22) with no significant difference (P=0.83). In cases with HPV detection information, the sensitivity of CIN2+ diagnosis by high-risk HPV detection in Beijing group and Guizhou group was 95.2% (40/42) and 73.6% (39/53) that was statistically significant (P<0.05). Conclusions: In both Beijing and Guizhou, the incidence of CIN2+ in elderly women is at a relatively high level. There were differences in the detection of CIN2+ by cervical cytology or HPV detection in Beijing and Guizhou.

Comparative effectiveness of radiotherapy for early-stage hormone receptor-positive breast cancer in elderly women using real-world data.

BackgroundRadiotherapy is the recommended treatment after breast‐conserving surgery (BCS) for early‐stage breast cancer (BC). However, there is no clear evidence whether radiotherapy after BCS improves the survival of elderly women diagnosed with early‐stage hormone receptor‐positive (HR+) BC. The aim of this study was to investigate the survival benefit associated with radiotherapy plus hormonal therapy vs hormonal therapy alone after BCS for early‐stage HR+ BC patients.MethodsUsing the Surveillance, Epidemiology, and End Results linked with Medicare data, we identified elderly (65 years and older) women diagnosed with early‐stage HR+ BC (2006‐2011) who received hormonal therapy with or without radiotherapy after BCS. A log‐rank test, Cox proportional hazards models, and propensity score matching were used to estimate the overall survival (OS) benefit associated with radiotherapy after BCS.ResultsOf the 5688 patients, there were 303 deaths from any cause. One hundred and eighty‐five (61%) of these deaths occurred in the hormonal therapy group, and 118 (39%) deaths occurred in the radiotherapy plus hormonal therapy group. The mean survival time in the radiotherapy plus hormonal therapy group was 5.32 ± 1.86 years compared with 4.92 ± 1.86 years in the hormonal therapy group. Based on the adjusted and propensity score matching analysis, patients in the adjuvant radiotherapy group had a lower risk of death compared with those who did not receive radiotherapy. Radiotherapy plus hormonal therapy decreased the risk of death by 32%. The effect estimates were similar in the adjusted and matched cohorts.ConclusionsRadiotherapy plus hormonal therapy resulted in a significant improvement in the OS of elderly women diagnosed with HR+ BC.

Combination of recurrent oral aphthae and dry eye syndrome may constitute an independent risk factor for oral cavity cancer in elderly women.

BackgroundFew studies have evaluated the risk of oral cavity cancer (OC) in patients with recurrent oral aphthae (ROA) and dry eye syndrome (DES). This study assessed the risk of OC in patients who had received diagnoses of ROA and DES in Taiwan.MethodsA population-based frequency-matched case–control study was conducted in which data were analyzed from the National Health Insurance Research Database of Taiwan. Patients with ROA and DES were identified as the case cohort. Patients and controls without ROA and DES were frequency matched (1:4) on the basis of age, sex, monthly income, geographical location, and urbanization level. Chi-squared tests were conducted to compare demographic factor distributions between the patients and controls. Cox proportional hazards models were used to calculate the adjusted hazard ratios (aHRs) and 95% CI of OC diagnoses among the patients and controls. Risk consistency between the two cohorts was determined using subgroup analysis.ResultsA total of 7,110 patients with ROA and DES and 28,388 controls were identified. The OC risk was significantly higher for female patients than controls (aHR=3.41, 95% CI=1.69–6.86). Furthermore, women aged 50–69 years exhibited a higher risk of OC than those in the other age groups. Female patients aged 50–59 years exhibited the highest aHR for OC (aHR=5.56, 95% CI=1.70–18.25), followed by those aged 60–69 years (aHR=4.34, 95% CI=1.26–15.99).ConclusionROA and DES may be associated with a high risk of OC in elderly women.

Treatment strategies and predicting prognoses in elderly patients with breast cancer.

ObjectiveThe prevalence of breast cancer in elderly women (older than 80 years) is expected to rise more dramatically than its incidence. In this study, we evaluated the evidence for treatment guidelines for elderly breast cancer patients.Patients and methodsAll included patients were enrolled from 2010 to 2013 from the Surveillance, Epidemiology, and End Results (SEER) database. The Akaike information criterion (AIC) and Harrell’s C statistic were used to perform comparisons. In addition, a propensity score analysis was used to avoid bias caused by data selection criteria. Prognostic factors were selected as nomogram parameters to develop a model to predict survival.ResultsA total of 16998 patients included in the SEER database from 2010 to 2013 had breast cancer and fulfilled the study criteria. Of whom, 13007 patients underwent surgery. Overall survival and cancer-specific survival were significantly better in patients who underwent surgery and/or radiotherapy than in those who did not (P<0.001). In addition, a nomogram system with a C index of 0.83 and an AIC index of 11112.85 was better able to predict prognoses and estimate cancer-specific survival in elderly patients with breast cancer.ConclusionA localized surgical approach might provide better results in elderly breast cancer patients. However, radiotherapy improved cancer-specific survival and overall survival in these patients. In addition, a prognostic nomogram directly quantified patient risk by accounting for various prognostic factors without forming risk groups and was better able to estimate cancer-specific survival.

Can Vulnerable Elders Survey-13 predict the impact of frailty on chemotherapy in elderly patients with gynaecological malignancies?

The management of gynaecological cancers in elderly women and high-risk patients is an even more relevant issue, because the increase in longevity and comorbidities. The assumption of frailty based on age alone may lead to inadequate and inappropriate treatment and frailty assessment is recommended. The aim of this study was to assess if Vulnerable Elders Survey-13 (VES-13), as indicator of frailty, can predict the toxicity of chemotherapy in gynaecological cancers.VES-13 was administered to patients aged ≥ 70 years with ovarian, endometrial and cervical cancers who underwent chemotherapy from 2010 to 2016.Eighty-four patients aged ≥ 70 years (mean age 74.6) were included, 36 patients (42.9%) resulted vulnerable (score ≥ 3). Thrombocytopenia and anaemia were more prevalent in the vulnerable subjects (81.3% versus 18.7%, P = .0005, and 81.8% versus 18.2%, P = .005, respectively), while neutropenia was similar between the 2 groups. Vulnerable women had higher risk of non-haematological toxicities. Most of the patients (77.4%) completed chemotherapy, but dose reductions and discontinuations were more common in the vulnerable group (66.7% versus 33.3%, P = .07 and 68.4% versus 31.6%, P = .01, respectively).To our knowledge, this is the first study to evaluate VES-13 exclusively in elderly women with gynaecological cancers. VES-13 may be useful to stratify this category of patients according to vulnerability in order to identify women at risk of toxicity and to prevent complications induced by chemotherapy.

Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients?

Developed countries face significant population ageing in the near future. Within 20years, the average age will approach 50years and the largest population cohort will be those over 65years. The incidence of breast cancer increases with age, with a risk in women of 0.44% by the age of 30, 3.82% by the age of 70 and 10% by the age of 80. Breast cancer is responsible for one out of every three cancer-related deaths. Elderly patients have higher mortality rates and most breast cancer-related deaths are observed in women over 65. There appears to be a trend that elderly patients with breast cancer receive less than the standard treatment compared to younger counterparts and this leads to poorer outcomes. The rationale for treating elderly breast cancer patients more conservatively is that breast cancers in this cohort are more commonly oestrogen receptor (ER) positive which gives the clinician the option to treat with hormonal manipulation alone. In addition, elderly patients present at a later stage compared to younger patients who frequently present with early (stages I and II) breast cancer. This review aims to give an overview of the diagnosis, treatment options and surveillance of breast cancer in elderly women (over 75years) and to discuss the change in perception of the term 'elderly' and the reasons for undertreatment in the elderly patients.

Omitting Adjuvant Radiotherapy for Hormone Receptor‒Positive Early-Stage Breast Cancer in Old Age: A Propensity Score Matched SEER Analysis.

PurposeThe purpose of this study was to investigate the non-inferiority of omitting radiotherapy (RT) after breast-conserving surgery (BCS) for hormone receptor (HR)‒positive T1N0 breast cancer in elderly women.Materials and MethodsFrom 2004 to 2014, HR-positive T1N0 breast cancer patients aged 50 years or older and receiving BCS were retrieved from the Surveillance, Epidemiology, and End Results 18 database. After propensity score matching between the no-RT and RT groups, univariate and multivariate analyses were performed. Identified prognostic factors were used to stratify the risk groups. In each risk group, 10-year cancer-specific survival (CSS) rates were compared between the no-RT and RT groups.ResultsAfter propensity score matching, the numbers of patients in the no-RT and RT groups were both 18,586. For patients who satisfied both a tumor size of 1-10 mm and a tumor grade of 1-2, omitting RT did not decrease the CSS rate at any age group, ranging from ≥ 50 to ≥ 85 years; for patients aged ≥ 50 years, the 10-year CSS rates in the no-RT and RT groups were 97.2% and 96.8%, respectively (adjusted hazard ratio, 0.862; p=0.312). However, for patients with a tumor size of 11-20 mm or tumor grade of 3-4, RT significantly increased the CSS rate irrespective of age.ConclusionRT after BCS for HR-positive T1N0 breast cancer in elderly women might be omitted without causing a decrease in the CSS rate, but only in patients who satisfy both a small tumor size (≤ 10 mm) and low tumor grade (1-2).

Incidence and Characteristics of Cervical Cancer in Elderly Women [3Q

INTRODUCTION: Cervical cancer screening guidelines currently recommend cessation of screening after the age of 65 in the absence of previous dysplasia. Patients over the age of 65 are still susceptible to the disease however. This project aims to describe the incidence of cervical cancer in elderly patients as well as characteristics of their disease. METHODS: The American College of Surgeons’ National Cancer Database was queried for cervical cancer patients aged 18-99. Variables collected included age, grade, stage, and histology of the disease. Multivariate regression and Cox proportional hazard models were performed to analyze association between the variables as well as survival data. RESULTS: A total of 18,015 patients were included in the analysis. Of the patients included, 21% were over the age of 65. Older age was associated with higher grade and stage of disease at time of diagnosis (P&lt;.0001). Older patients were also noted to do more poorly, with an increased risk of death of 1.3% for every year older a patient was at time of diagnosis (95% CI 1.0%-1.64%). CONCLUSION: Cervical cancer is as much a disease of the elderly as it is a disease of the young. It is important for clinicians to remain vigilant when screening for the disease and to obtain a proper history, including previous history of dysplasia, when treating these patients. Older patients diagnosed with the disease have typically more advanced and more aggressive disease than their younger counterparts.

EP-1303: Less is good: once-weekly hypofractionated radiotherapy for early breast cancer in elderly women

EP-1303: Less is good: once-weekly hypofractionated radiotherapy for early breast cancer in elderly women

Practical consensus recommendations regarding the management of hormone receptor positive early breast cancer in elderly women.

Breast cancer is a leading cause of death among women, and its incidence increases with age. Currently the treatment of breast cancer in older patients is almost identical to their younger counterparts. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists regarding the management of early breast cancer specifically in elderly women.

Practices and Knowledge on the Prevention of Cervical Cancer in Elderly Women

Cancer is a public health problem, primarily in developing countries. Elderly women are more prone to contracting different diseases, including sexual related neoplasms. The aim of this study was to determine the strategies used and knowledge regarding the prevention of cervical cancer in elderly women. This is a cross-sectional observational study. The sample was comprised of elderly women residents from the Brazilian Northeastern city who attended a coexistence group for elder people. After sample, calculation was obtained N of 209 participants. Associations between the independent and dependent variables were analyzed using the chi-squared test, considering p ≤ 0.05 as significant. The following programs were used for statistical analyses: Excel (Microsoft Office®), to tabulate the data and prepare the tables and Bioestat® 5.3 to test the associations. The prevalent age range was 60 to 70 years; most of the subjects were retired and had secondary schooling. Although a large number of those interviewed knew about cervical cancer, their knowledge was insufficient to take preventive measures. It is important that the elderly undergo a Pap smear, since the number of increasing cervical cancer cases is known to increase in this age range. In the coming decades, Brazil will have a significant elderly population, reaffirming the growing need for educational campaigns related to the health of elderly women, encouraging self-care and prevention in old age.

Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review.

Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. We reviewed 63 original articles published between 2006 and 2016 concerning women over 70years with breast cancer. Compared to patients 70-79years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p<0.01) and more T2 lesions (43.5% vs 33.0%, p<0.01). Lymph nodes and distant metastases were more frequent, with more N+(49.5% vs 44.0%, p<0.01) and more M1 (8.0% vs 5.9%, p<0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p<0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p=0.01) and fewer grade 3 (21.5% vs 25.5%, p<0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p<0.01). Lympho-vascular invasion was less frequent in the 80years and over (22.9% vs 29.7%, p=0.01). Breast cancer-specific mortality was higher both at 5years (25.8% vs 17.2%, p<0.01) and 10years (32.7% vs 26.6%, p<0.01). Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.

The Use of Hormone Therapy Alone Versus Hormone Therapy and Radiation Therapy for Breast Cancer in Elderly Women: A Population-Based Study

The Cancer and Leukemia Group B (CALGB) 9343 trial randomized elderly women with estrogen receptor-positive, stage 1 breast cancer to receive either hormone therapy (HT) or HT and radiation therapy (HT-RT) after lumpectomy and showed no difference in survival. After this publication, a practice guideline made HT alone a standard treatment option in British Columbia. The subsequent population-based pattern of practice was studied. All women aged 70 to 79years, referred after lumpectomy from 1999 to 2009, with stage 1, estrogen receptor-positive breast cancer were identified. The use of adjuvant HT or HT-RT was evaluated in 2 eras: before (1999-2003) and after (2005-2009) the CALGB publication. The proportion receiving each treatment in these eras was determined. Kaplan-Meier analyses with Cox regression were used for survival endpoints. The Fine and Gray method was used with non-breast cancer death as a competing risk for event-free survival.The Charlson score was used to quantify comorbidity. Adherence was defined as dispensation of 80% of prescribed HT. HT-RT was used in 91% of patients before (n=319) and 89% of patients after (n=403) the CALGB publication (P=.4). In the HT-alone group, the rate of HT adherence was 75% at 1year and 55% at 4years. The 10-year locoregional recurrence-free survival rate was 98% with HT-RT and 90% with HT alone (P=.01), whereas the 10-year breast cancer-specific survival rate was 96% with HT-RT and 95% with HT alone (P=.2). Patients with grade 3 histology or lymphovascular invasion were more likely to have low event-free survival. On multivariate analysis, treatment type did not predict overall survival (P=.3). Our patient outcomes closely matched those of the CALGB trial, suggesting that its results are generalizable to a population of elderly breast cancer patients with typical HT adherence. The CALGB trial results, as well as the resulting practice guideline, did not change the use of adjuvant HT-RT in our population-based cancer program.