Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival

Yancik, Rosemary; Ries, Lynn; Yates, Jerome W.

doi:10.1002/1097-0142(19890301)63:5<976::aid-cncr2820630532>3.0.co;2-a

Cited by 270 publications

(115 citation statements)

References 9 publications

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“…Similar findings have been reported from various countries (Polednak, 1986;Yancik et al, 1989;Coates et al, 1992;Afzelius et al, 1994;Fowble et al, 1994;Ramirez et al, 1999). Several explanations why patient delay is more often found among older women have been suggested.…”

Section: Discussionsupporting

confidence: 87%

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.

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Section: Discussionsupporting

confidence: 87%

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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“…Older women were more likely to present with locally advanced and metastatic disease, as has previously been shown (Yancik et al, 1989). This excess of advanced disease in the older age group persists even when symptomatic patients only were examined.…”

Section: Discussion Tumour Stagesupporting

confidence: 65%

“…This dilutes any survival benefit from breast cancer treatment so differences may be difficult to detect. Stage at presentation also differs in older women because they are less likely to self-examine (Siahpush and Singh, 2002) and therefore the size of the primary cancer is greater at diagnosis (Diab et al, 2000;Golledge et al, 2000), and the incidence of advanced disease may be greater (Yancik et al, 1989).…”

Section: Stage Differences At Presentationmentioning

confidence: 99%

Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines

et al. 2004

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Breast cancer-specific mortality is static in older women despite having fallen in younger age groups, possibly due to lack of screening and differences in treatment. This study compared stage and treatment between two cohorts of postmenopausal women (55 -69 vs 470 years) in a single cancer network over 6 months. A total of 378 patients were studied (470: N ¼ 167, 55 -69 years: N ¼ 210). Older women presented with more advanced disease (470: metastatic/locally advanced 12%, 55 -69 years: 3%, Po0.01). Those with operable cancer had a worse prognosis (Nottingham Prognostic Index (NPI) 470: median NPI 4.4, 55 -69 years: 4.25, Po0.03). These stage differences were partially explained by higher screening rates in the younger cohort. Primary endocrine therapy was used in 42% of older patients compared with 3% in the younger group (Po0.001). Older women with cancers suitable for breast conservation were more likely to choose mastectomy (470: 57.5% mastectomy rate vs 55 -69 years: 20.6%, Po0.01). Nodal surgery was less frequent in older patients (470: 6.7% no nodal surgery, 55 -69 years: 0.5%, Po0.01) and was more likely to be inadequate (470: 10.7% o4 nodes excised, 55 -69 years: 3.4%, Po0.02). In summary, older women presented with more advanced breast cancer, than younger postmenopausal women and were treated less comprehensively.

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“…6 -9 Multivariate analyses to assess associations of age and menopausal status with other clinical and pathologic characteristics have not consistently retained either variable as an independent adverse prognosticator, 8 although several multivariate analyses have indicated that young age or premenopausal status are independent predictors of disease recurrence. 10 -13 In addition, a few studies have found that those women at the extremes of age, i.e., premenopausal women younger than 33 years of age 11 or postmenopausal women older than 80 -85 years of age, 3,14 had a worse prognosis than other age groups.…”

mentioning

confidence: 99%

Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre‐ and postmenopausal women

Talley

Grizzle

Waterbor

et al. 2001

Intl Journal of Cancer

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Breast cancers in younger, premenopausal women are more likely to exhibit an adverse prognostic profile (including negative steroid hormone receptors and a high rate of cellular proliferation) and poor outcome than breast cancers in postmenopausal women. It has been hypothesized that this adverse prognostic profile is a result of the higher histologic grade of breast cancers in pre-compared with post-menopausal women. To assess the association of expression of steroid hormone receptors and indicators of proliferation while controlling for histologic grade, we identified 100 infiltrating ductal carcinomas from premenopausal women 45 years of age or younger and 100 from postmenopausal women 65 years of age or older. The carcinomas were selected so that the histologic grades (low versus high) were distributed equally between the 2 groups. Estrogen receptors (ER), progesterone receptors (PR), p27 Kip1 and Ki-67 (to measure rate of proliferation) were assessed by immunohistochemistry and compared between groups. Clinical information and survival data were also analyzed. ER content was lower and proliferation was higher in carcinomas in premenopausal women (p ‫؍‬ 0.048 and p ‫؍‬ 0.005, respectively). By univariate analysis, p27 Kip1 and PR were not different between the groups; however, in multivariate analysis, p27 Kip1 was higher in postmenopausal women, but only in a subgroup with highly proliferative carcinomas. Overall survival was similar in the pre-and postmenopausal women. Furthermore, low p27 Kip1 and African-American ethnicity predicted a poorer overall survival in the premenopausal, but not in the postmenopausal, women in our study. After controlling for histologic grade, a lower expression of ER and a higher proliferative index were detected in breast carcinomas in premenopausal women. Therefore, some prognostic indicators, such as ER and proliferative rate, may be more closely associated with menopausal status than histologic grade. Our data also suggest that some prognostic factors are not equally effective as predictors of survival in pre-and postmenopausal women. Prognosis in women with breast cancer has been reported to differ according to age and menopausal status. Studies examining this issue have varied in design, age categorization and outcome measures. A few large population-based studies and more limited analyses 1-5 have indicated that women under the ages of 30 -40 years have a worse prognosis. Some retrospective studies have attempted to explain the less favorable outcome in younger women and have reported that breast cancers in younger women exhibit more adverse characteristics, including a high clinical stage at diagnosis, high histologic grade, lack of steroid hormone receptors and increased proliferation. 6 -9 Multivariate analyses to assess associations of age and menopausal status with other clinical and pathologic characteristics have not consistently retained either variable as an independent adverse prognosticator, 8 although several multivariate analyses have indicated that young ag...

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Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival

Cited by 270 publications

References 9 publications

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines

Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre‐ and postmenopausal women

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