Does Age Matter? Estimating Risks of Locoregional Recurrence After Breast-conservative Surgery

Abstract

Background/Aim: In 2016, in the United States, more than 50% of breast cancer (BC) cases were diagnosed in patients older than 60 years of age. Our study aimed to estimate the risk of locoregional recurrence (LR) in patients who underwent breast-conservative treatment (BCT), according to age. Patients and Methods: This retrospective monocentric study analyzed 613 cases of patients who underwent BCT between 2003 and 2014. Patients were divided into groups according to age: Under70 (under 70 years old) and Over70 (above 70 years old). Margins width, histology results, prognostic and predictive factors were compared. Subgroup analysis was performed for patients who experienced LR. Results: LR Incidence among Under70 and Over70 was 5.4% and 1.7%, respectively (p<0.01). Group Over70 is characterized by larger tumors and a lower Ki67 index (p<0.01). Conclusion: Operation time reduction, better aesthetic results and reduced LR risk support BCT. The Over70 group exhibited better outcomes in terms of LR despite larger tumor dimensions. Recent research of global cancer concludes that breast cancer (BC) represents the second most common cause of neoplasms with an overall number of more than 2 million cases worldwide (1). Demographic transition in developed countries predetermines increase in life expectancy and growth of the elderly population. Consequently, the growing numbers of BC diagnosis in aged patients point out the importance of a tailored approach even in this target population, avoiding undertreatment (2-4). Moreover, it is demonstrated that age is a strong factor influencing patient's choice of refusing surgery, with other demographic and disease-specific characteristics (5). In 2016, more than 50% of BCs were diagnosed in patients older than 60 years (6). Surgical management of BC is divided into two approaches: Mastectomy (Mx) and breastconservative treatment (BCT) (7, 8). Mx consists of breast gland complete removal with the possibility of sparing the Nipple Areola complex (9, 10). Breast reconstruction (BR) should be considered and offered to patients who undergo mastectomy, if not contraindicated by performance status or clinical stage of disease (11-13). Modern conception of breast surgery treatment shifts from preserving the breast appearance specifically to improvement of the general body image through an oncoplastic surgical technique (10, 14). BR can be performed through several techniques including lipofilling, myo-cutaneous autologous flaps and prosthetic implants (15, 16). Breast implants represent the first preference in 81.2% of cases (17). Between the years 2014 and 2018 the rate of Mx following immediate BR increased from 6.7% to 18.1% in women 65 years old or older (18). With that said, patients older than 65 1125 This article is freely accessible online.

Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients

“…The higher incidence of nodes involvement and local advanced stage could be partially related to the screening suspension and delayed diagnosis (6). Additionally, we observed a different distribution of cancer grades, which could also be partially correlated with lymph nodes advanced stages (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Nonetheless, at multivariate analysis, waiting time on list, significantly longer during the Lockdown, seems to be the only predictive factor of lymph nodes involvement progression.…”

“…N staging distribution seems to be more advanced in the lockdown group with incidence of N2 being significantly higher (32,33). Involvement and number of positive lymph nodes are prognostic factors of breast cancer (34)(35)(36)(37)(38). The higher incidence of nodes involvement and local advanced stage could be partially related to the screening suspension and delayed diagnosis (6).…”

Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency

“…Resource saving policy could lead to more operative room and beds availability, even for COVID-19 patients. This way, BCS could not be restricted to frail patients only as general practice [17,18], but extended to other patients. When Mx is not avoidable, breast reconstruction choice should be made by surgeon to reduce as much as possible the surgical stress and to allow fast discharge at home, as a classical paradigm [19].…”

Breast cancer patients with hormone neoadjuvant bridging therapy due to asymptomatic Corona virus infection. Case report, clinical and histopathologic findings

“…Waiting time between diagnosis and surgery in our case was about 6 months. During the pandemic, oncological diagnostic procedures and treatments experienced a significant slowdown [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. In our opinion waiting time can influence breast cancer staging [ 3 ].…”