Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival

Boston University, Boston, Massachusetts, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2010; 28(12):2038-45. DOI: 10.1200/JCO.2009.25.9796
Source: PubMed


PURPOSE Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. PATIENTS AND METHODS We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, > or = 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer-related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age > or = 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age > or = 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). CONCLUSION Women age > or = 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.

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Available from: Rebecca A Silliman, Apr 07, 2015
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    • "In the USA, mastectomy was performed in less than 40% of patients aged 80 years or older with stage I disease and in approximately 62% of patients with stage II disease [13]. In the US, following breast-conserving surgery in stage I and II of the disease, breast irradiation was performed in 31% of patients with stage I cancer and in 15% of patients with stage II cancer [13]. Due to a high proportion of patients who underwent mastectomy, irradiation was performed only in 12% of our patients. "
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    ABSTRACT: Background The population of elderly people is increasing and so is the population of breast cancer patients aged ≥80 years. The aim of our retrospective study was to identify independent prognostic factors for the duration of breast cancer-specific survival of surgically treated patients aged ≥80 years. The secondary aim was to determine the appropriate surgical treatment of breast cancer in patients aged ≥80 years. Methods We reviewed the medical records of 154 patients aged ≥80 years with early-stage breast cancer (mean age 83 years) who underwent surgery at the tertiary cancer center in the period from 2000 to 2008. Tumor stage was pT1/pT2 and pT3/pT4 in 75% and 25%, respectively. Surgical treatment comprised: quadrantectomy (in 27%), mastectomy (in 73%), axillary dissection (in 57%), and sentinel lymph node biopsy (in 18%), while 25% of patients had no axillary surgery. Results During a median follow-up of 5.3 years, 31% of patients died of breast cancer, while 28% of patients died of other causes. Half of our patients with poorly differentiated breast cancer or estrogen receptor-negative tumor died of breast cancer. Multivariate statistical analysis showed that the pathological T-stage, pathological N-stage and estrogen receptors were independent prognostic factors for the duration of breast cancer-specific survival of patients. Conclusion Short breast cancer-specific survival indicates that, in patients aged ≥80 years, breast cancer with metastases in axillary lymph nodes can be an aggressive disease.
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    • "Currently, approximately 40 out of 100 thousand women in China are suffering from breast cancer. Generally, the patients older than 60 years old were prone to malignant tumors despite of slow disease progression, whereas the younger ones were commonly subjected to rapid progression.14 "
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    ABSTRACT: Objective: To explore the correlation between the clinical pathologies of breast cancer in the elderly and youths as well as their prognosis. Methods: Two hundred and eighty breast cancer patients were divided into a youth group (<60, n=120) and an elderly group (≥60, n=160) according to the age. Their routine clinical pathological indices and immune indices were observed and determined, and the prognosis was observed after effective treatment. Results: The positive expression rates of p63, CK5/6, CK14 and CK17 in the elderly group were significantly higher than those of the youth group (P<0.05). The tumor-free survival rate of the youth group (95.8%) was significantly higher than that of the elderly group (84.4%) (P<0.05). Multivariate Logistic regression analysis showed that the positive expressions of p63 and estrogen receptor, age, and postoperative chemotherapy were the independent risk factors of tumor-free survival rate (P<0.05). Conclusion: The immunohistochemical typing characteristics of the elderly and youths were different, and the prognosis of young patients was better, being correlated with the typing.
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    • "Comorbidity adversely impacts the treatment [1] [2] [3] [4] [5] [6] [7] and outcomes [1, 3, 6, 8–22] of breast cancer, especially in older patients. For instance, studies have shown that breast cancer patients with previously identified comorbidity are less likely to receive adjuvant chemotherapy [2] [4] [5] and have higher mortality [8]. "
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