What are the clinicopathological features of elderly early-stage breast cancer patients and is there any difference in patients over 70 years of age?
Received Date : 16 Feb 2019
Accepted Date : 12 Apr 2019
Doi: 10.1016/j.jons.2019.04.002 - Article's Language: EN
J Oncol Sci 5 (2019) 49-53
This is an open access article under the CC BY-NC-ND license
Aim: Although patients over 65 years of age are considered to be elderly patients with breast cancer, the performance status and comorbidity of patients aged 70 and over is not the same as patients aged 65e70 years. The aim of this study was to evaluate the treatment modalities, features of patients and disease in elderly early-stage breast cancer patients. Material and methods: Data of 87 patients were examined. Demographic data, disease data (tumor size, lymph node involvement, hormone receptor status, Her-2 status), comorbid diseases, and given treatments were evaluated. The patients were divided into two groups as 65e70 years of age and over 70 years of age. All the collected data was compared. Results: There was no difference in hormone receptor status between 2 groups (p > 0,05). Her-2 negativity was found to be significantly higher in patients  70 years (%61 vs %83, p ¼ 0,024). There was no significant difference between two groups in terms of surgery (p > 0,05). The frequency of chemotherapy and radiotherapy was significantly lower in the older group (%37 vs %17, p ¼ 0,009). OS and DFS were significantly shorter in triple negative disease (69.59 months,p ¼ 0.039 and 53.95 months,p ¼ 0.024 respectively). ER positive subtype has a significantly better DFS (164 vs 47 months, p ¼ 0,037) and OS (170 vs 68 months, p ¼ 0,046). Additionally, PR positive disease has a significantly better DFS (129 vs 84 months, p ¼ 0,028) and OS (190 vs 96 months, p ¼ 0,006). HER2-negative subtype had better OS than HER2-positive subtype (172 vs 91 months, p ¼ 0,016). DFS was significantly shorter in 70years patients (161.1 months vs 102.1 months, p ¼ 0.045), however OS was not different among the 2 groups. Adjuvant therapy prolongs DFS in both groups(65e70 years 107,5 vs 129,3 months, >70years 86,2 vs 95,7 months p ¼ 0,034). Conclusion: Age is an important and independent risk factor for the treatment of the elderly patients, however patient age alone cannot be decisive. In current study, the pathological features of the tumor and the effects of these features on DFS and OS were similar in young breast cancer patients and patients over 70 years of age. In addition, we found that adjuvant treatment modalities affect OS and DFS positively as in the case of young patients. There is an absolute need for prospective studies involving elderly patients.
  1. Freedman RA. Treatment of breast cancer in the elderly. Curr Oncol Rep. 2015 Nov;17(11):51. [Crossref]  [PubMed] 
  2. Barthelemy P, Heitz D, Mathelin C, et al. Adjuvant chemotherapy in elderly patients with early breast cancer. Impact of age and comprehensive geriatric assessment on tumor board proposals. Crit Rev Oncol Hematol. 2011 Aug;79(2): 196e204. [Crossref]  [PubMed] 
  3. Cappellani A, Di Vita M, Zanghì A, et al. Prognostic factors in elderly patients with breast cancer. BMC Surg. 2013;13(Suppl 2):S2. [Crossref]  [PubMed]  [PMC] 
  4. Biganzoli L, Wildiers H, Oakman C, et al. Management of elderly patients with breast cancer: updated recommendations of the international society of geriatric Oncology (SIOG) and european society of breast CancerSpecialists (EUSOMA). Lancet Oncol. 2012 Apr;13(4):e148ee160. [Crossref] 
  5. Dimitrakopoulos FI, Kottorou A, Antonacopoulou AG, Makatsoris T, Kalofonos HP. Early-stage breast cancer in the elderly: confronting an old clinical problem. J Breast Cancer. 2015 Sep;18(3):207e217. [Crossref]  [PubMed]  [PMC] 
  6. Luque M, Arranz F, Cueva JF, et al. Breast cancer management in the elderly. Clin Transl Oncol. 2014 Apr;16(4):351e361. [Crossref]  [PubMed] 
  7. Punglia RS, Hughes KS, Muss HB. Management of older women with earlystage breast cancer. Am. Sociol. Clin. Oncol. Educ. Book. 2015:48e55. [Crossref]  [PubMed] 
  8. Brouwers B, Dalmasso B, Hatse S, et al. Biological ageing and frailty markers in breast cancer patients. AGING. 2015 May;7(5):319e333. [Crossref]  [PubMed]  [PMC] 
  9. Inal A, Akman T, Yaman S, et al. Pathologic and clinical characteristics of elderly patients with breast cancer: a retrospectiveanalysis of a multicenter study (Anatolian Society of Medical Oncology). Int Surg. 2014 Jan-Feb;99(1):2e7. [Crossref]  [PubMed]  [PMC] 
  10. Holmes CE, Muss HB. Diagnosis and treatment of breast cancer in the elderly. CA. Cancer J Clin. 2003 Jul-Aug;53(4):227e244. [Crossref]  [PubMed] 
  11. Oran ES, Yankol Y, Soybir GR, et al. Distinct postsurgical management in young and elderly breast cancer patients results in equal survival rates. Asian Pac J Cancer Prev APJCP. 2014;15(18):7843e7847. [Crossref]  [PubMed] 
  12. Jueckstock J, Kasch F, Jaeger B, Schramm A, Janni W, Scholz C. Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis. Arch Gynecol Obstet. 2015 Nov;292(5):1101e1107. [Crossref]  [PubMed] 
  13. Aaldriks AA, Giltay EJ, le Cessie S, et al. Prognostic value of geriatric assessment in older patients with advanced breast cancer receiving chemotherapy. Breast. 2013 Oct;22(5):753e760. [Crossref]  [PubMed] 
  14. Abdel-Rahman O, ElHalawani H. Adjuvant systemic treatment for elderly breast cancer patients; addressing safety concerns. Expert Opin Drug Saf. 2014 Nov;13(11):1443e1467. [Crossref]  [PubMed]