Early Breast Cancer in the Elderly: Characteristics, Therapy, and Long-Term Outcome

Abstract

Objective: The number of older adults diagnosed with breast cancer is increasing. However, data on breast cancer characteristics, treatment, and survival in elderly women are sparse. Methods: The database of a tertiary cancer center was searched for all women aged ≥65 years who were diagnosed with early breast cancer in 2004-2007. Patients were divided into 2 age groups: 65-75 years and >75 years. Data on tumor, treatment, and outcome parameters were compared. Results: The cohort included 390 patients. The older group underwent more mastectomies but less axillary surgery or adjuvant systemic therapy. Median overall survival (OS) was 9.5 years in the older group and not reached in the younger group; the 8-year disease-free survival rates were 85 and 88%, respectively (p = 0.27). Both age and tumor subtype had an effect on OS and recurrence rates (p < 0.001 for OS; p = 0.16 for recurrence). The worst outcome was noted in women aged >75 years with triple-negative (TN) disease. Conclusion: The treatment approach was different between both age groups, despite similar tumor characteristics. TN subtype presented as the most aggressive disease in both age groups. Physicians should be alert to these findings and select treatment on a case-by-case basis.

Observational study of coagulation activation in early breast cancer: development of a prognostic model based on data from the real world setting

“…Among the clinically relevant patient- and disease-related determinants of interest, age and tumour size (pT) showed prognostic relevance in uni- and multi-variate analysis and were thus included in the model for risk stratification. This evidence is consistent with previous literature from the early setting [ 20 , 21 ]. In strict regard to the patient age, our results provide several hints for discussion.…”

Variations in intrinsic breast cancer characteristics in screen‐detected breast cancer patients aged between 45 and 69 and above the age of 70

“…Despite the favourable breast cancer attributes in the older patients, however, breast cancer‐related mortality was significantly higher. This is also consistent with the literature 13,15 . Gal et al .…”

“…analysed the results of 390 patients with early breast cancer and identified higher mortality of patients aged >75 years as compared to patients aged 65–75 years. Risk of breast cancer‐related death for the older group as compared to the younger group was found to be 2.2 (95% confidence interval 1.1–4.4) 15 . This may be multifactorial, including late diagnosis as those in the post‐targeted screening groups may rely on symptomatology and self‐detection before the presentation.…”

Clinicopathological characteristics in women with breast cancer in extreme ages in Greece: A single centre experience

“…The poor outcomes observed among older patients can also be attributed to various comorbidities and its associated medications. Such comorbidities can affect the mortality of older women regardless of their breast cancer or its treatment [26]. Elderly women with early stage breast cancer and comorbid conditions are likely to die from other causes rather than their operable breast cancer [27,28].…”

“…All decisions should consider physiological age, estimated life expectancy, risks, benefits, treatment, tolerance, patient preferences, and potential treatment barriers [27]. Actually, underestimation of life expectancy and fitness for therapy might result in age-related undertreatment, which is itself a risk factor for breast cancer recurrence and death, and decisions regarding therapy for breast cancer should not be based on age alone [26,27]. Indeed, some studies show that these women are more likely to be surgically overtreated and receive less adjuvant therapies [21], while other studies emphasise the practice of monotherapy with endocrine treatments, such as tamoxifen or aromatase inhibitor alone, in HRpositive patients [25].…”