Management of early breast cancer in the elderly

Rao, Vittal; Garimella, Veerabhadra; Hwang, Mei-Ju; Drew, Philip

doi:10.1002/ijc.22431

Cited by 19 publications

(13 citation statements)

References 62 publications

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“…Older patients often receive less aggressive treatment than younger patients (Rao et al 2007), but a study of 118 women aged over 80 years with breast cancer showed that the women treated with letrozole had better progression-free survival than those treated with tamoxifen (progression was 5/64 and 24/54 respectively; Garimella et al 2006). In the BIG 1-98 trial, letrozole, compared with tamoxifen, significantly reduced the risk of recurrence by 21% in patients aged 65 years or older (HR 0.79;95% CI 0.64-0.97;PZ0.02;Thürlimann et al 2005), while in the ATAC trial, anastrozole reduced the risk of recurrence by only 7% in women aged 65 years and older (HR 0.93; 95% CI 0.80-1.08) when compared with tamoxifen (Arimidex package insert 2005).…”

Section: Efficacy and Safety Of Adjuvant Endocrine Therapy In Older Pmentioning

confidence: 99%

Menopausal symptoms and adjuvant therapy-associated adverse events

Hadji¹

2008

Endocrine Related Cancer

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Third-generation aromatase inhibitors (AIs) are replacing tamoxifen as adjuvant therapy in postmenopausal women with hormone-sensitive breast cancer due to their superiority shown in several recent head-to-head trials. Healthy postmenopausal women normally experience age-related side effects, and in postmenopausal women with breast cancer, these symptoms may be exacerbated by adjuvant endocrine therapy. This review evaluates the current literature regarding bone health, lipid metabolism, cardiovascular disease, gynecologic health, and cognition in postmenopausal women receiving adjuvant AI therapy. The AIs -anastrozole, exemestane, and letrozole -are generally well tolerated: most adverse events are mild to moderate and common to menopause. Common short-term AI-associated toxicities are hot flushes, musculoskeletal complaints/arthralgia, and bone loss, all of which can be effectively managed. AIs may lack the cardioprotective and lipid-lowering effects of tamoxifen but, in contrast to tamoxifen, do not increase the risk of serious life-threatening thromboembolic or cerebrovascular events or endometrial cancer. Every patient should be individually assessed with respect to therapy risks and benefits. Lifestyle, comorbidities, and concomitant medications must be considered, and the importance of compliance to adjuvant therapy should be discussed before selecting a treatment regimen. The superior efficacy of adjuvant AI therapy will in most cases outweigh the risk of bothersome side effects that can be prevented or easily managed.

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Section: Efficacy and Safety Of Adjuvant Endocrine Therapy In Older Pmentioning

confidence: 99%

Menopausal symptoms and adjuvant therapy-associated adverse events

Hadji¹

2008

Endocrine Related Cancer

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“…Although relatively little is known about possible differences in the biology of BC in older patients compared to younger patients, it has been reported that advanced age is associated with less aggressive tumor features (Tipples and Robinson, 2009;Tang et al, 2011;Thomas and Leonard, 2009;Wildiers, 2008;Rao et al, 2007;Thapa et al, 2013;Zhao et al, 2014). In addition, an understanding of the relationship between age and life expectancy is vital in making clinical decisions regarding treatment (Rao et al, 2007). The average future life expectancy of a 65-year-old woman is nearly 20 years and that of an 80-year-old woman is 9 years (Tang et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…The average future life expectancy of a 65-year-old woman is nearly 20 years and that of an 80-year-old woman is 9 years (Tang et al, 2011). Both reductions in life expectancy and an increased frequency of comorbid illnesses account for diversions in standard BC treatment algorithms in elderly patients (Rao et al, 2007;Wyld and Reed, 2007). Treatment-related morbidity plays a significant role in the application of curative treatment in elderly patients; older patients are more likely to prefer an improvement in their current quality of life rather than a potential increase in survival (Yellen et al, 1994).…”

Section: Introductionmentioning

confidence: 99%

Distinct Postsurgical Management in Young and Elderly Breast Cancer Patients Results in Equal Survival Rates

Oran

Yankol²,

Soybir³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Although breast cancer (BC) is one of the most common malignant diseases in women, the majority of the studies describing the characteristics of BC in elderly patients have been limited to survival assessments or tumor features, without using younger BC patients as a reference group. The aim of our study was to describe and compare tumor characteristics and management patterns in elderly versus younger breast cancer patients in Turkey. Materials and Methods: We retrospectively analyzed 152 patients with invasive breast cancer who underwent surgery in our institution between 2002 and 2012. Patients were divided into 2 groups according to age at the time of diagnosis. Results: There were 62 patients in the elderly group (≥65 years) and 90 patients in the younger group (<65 years). Compared to the younger group, tumors in the elderly group were more likely to be larger (p=0.018), of lower grade (p=0.005), and hormone receptor-positive (p>0.001). There were no significant differences regarding histology, localization, lymph node involvement, or types of surgical procedures between the 2 groups. Comorbidities were more common in elderly patients (p<0.001). In addition, elderly patients were more likely to receive hormonal therapy (p<0.001) and less likely to receive radiotherapy (p=0.08) and chemotherapy (p=0.003). There was no difference in survival and locoregional recurrence rates between the groups. Conclusions: The results of this study demonstrate that breast cancer in elderly patients has more favorable tumor features, warranting less aggressive treatment regimens after surgery.

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“…Age is the greatest risk factor for the development of new cases of breast cancer, and the incidence increases with age: 1 in 50 by age 50, 1 in 14 by age 70 and 1 in 9 by age 85 (2). Approximately 50% of breast cancers occur in women of 65 years of age or older and 35% occur after the age of 70 (3).…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological features and treatment sensitivity of elderly Chinese breast cancer patients

et al. 2010

Oncology Letters

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Abstract. This study aimed to determine the clinicopathological features and treatment sensitivity of elderly breast cancer patients in China. The clinical data of 594 elderly breast cancer patients of 70 or more years of age were collected and compared to those of 657 patients of less than 70 years of age to analyze whether breast cancer in the elderly is different and whether the difference affected outcome. The median age was 75.2 years in the elderly patients and 49.8 years in the young patients. Age of menarche, parous status and body mass index were similar in the two groups. A higher frequency of steroid receptor-positive rate, a lower expression of HER-2 and p53, less axillary node-positive rate and earlier tumor stage were found in patients of 70 years or older. The 5-year relapse-free survival (RFS) and overall survival (OS) was 77 and 82% in the elderly and 86 and 93% in the young patients, respectively. Patients with estrogen receptor (ER)-positive or lymph node (LN)-negative cancers showed a more favorable outcome in the elderly patients. RFS and OS were increased in elderly patients who underwent endocrine therapy or omitted chemotherapy. Breast cancer in the elderly had more favorable tumor features, using estrogen receptor and lymph node status as prognostic factors. It was therefore concluded that adjuvant endocrine therapy may benefit elderly patients, while chemotherapy may not.

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Management of early breast cancer in the elderly

Cited by 19 publications

References 62 publications

Menopausal symptoms and adjuvant therapy-associated adverse events

Menopausal symptoms and adjuvant therapy-associated adverse events

Distinct Postsurgical Management in Young and Elderly Breast Cancer Patients Results in Equal Survival Rates

Clinicopathological features and treatment sensitivity of elderly Chinese breast cancer patients

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