Could Patients Older than 75 Years Benefit from a Systematic Breast Cancer Screening Program?

Ilenko, Anna; Sergent, F.; Mercuzot, Antonin; Zitoun, Mickaël; Chauffert, Bruno; Foulon, Arthur; Gondry, J.; Chevreau, Julien

doi:10.21873/anticanres.11397

Cited by 6 publications

(2 citation statements)

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“…Although we do not have tools capable of predicting the risk of recurrence with certainty, many factors are reported in the current literature as predictors of DCIS upstaging to invasive cancer (39,40). Both pre-operative radiological features, histological characteristics are reported as predictive factors of DCIS upstaging (40)(41)(42)(43). In our analysis, we reported an increased incidence of nodular lesions in the elderly patients.…”

Section: Discussionmentioning

confidence: 61%

Surgical Treatments for Ductal CarcinomaIn Situ(DCIS) in Elderly Patients

et al. 2023

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Background/Aim: Despite an aging population, there is no consensus regarding ductal carcinoma in situ (DCIS) treatment for elderly women. Breast surgery can be well tolerated even in elderly patients. The aim of this study is to evaluate the surgical management of DCIS in elderly patients. Patients and Methods: We retrospectively analyzed patients with DCIS from 2016 to 2022 at our Breast Unit and divided our population according to age. Results: Out of 231 patients with DCIS, 45 (19.5%) were elderly. The Charlson comorbidity index and American Society of Anesthesiology (ASA) score was significantly higher in the elderly (p<0.001 for both). Among the elderly, 10 (22.2%) patients received upstaging diagnoses, versus 18 (9.7%) in the control (p=0.048). Twelve (26.7%) of the elderly patients underwent sentinel lymph node biopsy, versus 93 (50%) in the control group (p=0.005). No difference was reported between groups in terms of breast conserving surgeries performed. A higher incidence of surgeries performed using local anesthesia was reported in the elderly group (p=0.041). Thirty-day surgical complications, according to Clavien-Dindo, did not show significant differences. Conclusion: Despite higher comorbidity and ASA score, breast surgery is safe and feasible in elderly patients. Due to the higher risk of upstaging to invasive ductal carcinoma, surgery should be performed but sentinel lymph node biopsy should be omitted, owing to the low risk of lymph node metastasis and lower use of adjuvant treatments.

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Section: Discussionmentioning

confidence: 61%

Surgical Treatments for Ductal CarcinomaIn Situ(DCIS) in Elderly Patients

et al. 2023

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“…In Reply Drs Seidenwurm and Breslau state in their letter that women in their 80s and 90s are not likely to live long enough to benefit from early detection, but such a blanket statement is both incorrect and dangerous; many such women remain healthy with at least 5 to 10 years of life expectancy. Indeed, multiple observational and modeling studies have demonstrated that women 75 years and older who undergo regular mammography not only will be diagnosed with earlier-stage cancers but also will experience a significant number of life-years gained and a significant reduction in breast cancer mortality . In fact, screening mammography in aging populations detects disease at an earlier stage and reduces recognized age disparities in breast cancer mortality .…”

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confidence: 99%

Data-Driven Mammography Screening Practices—Reply

2018

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that a marginal improvement in overall survival in an ideal population may be lost when that therapy is extrapolated to a realworld population. It is likely the case that a marginal benefit to disease-specific survival is also diluted or lost in the world because the mechanism of the loss is due to an increase in toxicity, frequent dose reductions, and discontinuations, 2 leading to a tipping of the benefit/harm balance.Ultimately, patients care about 1 of 2 things: living longer or living better. Overall mortality directly measures living longer, while disease-specific mortality measures only death due to the target cancer. A hypothetical cancer drug that increases cardiovascular death to the same degree that it decreases cancer death would show no benefit on overall mortality, but a benefit in disease-specific mortality. It is even possible for a drug to reduce disease-specific mortality while increasing overall mortality. For this reason, we believe that the competing risk is another challenge faced in drug development, and effective drugs must improve not only diseasespecific but also overall survival, and not just in the idealized setting but the real world as well.

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