Management of early breast cancer in older women: from screening to treatment

Abstract

BackgroundBreast cancer is a common condition. It is a leading cause of death among women, and its incidence increases with age. Aging of the population and improvement of the quality of life of elders make it a major public health issue. We reviewed the literature to try to determine the management of breast cancer in older women.MethodsWe conducted a narrative review by literature searches using key words “breast cancer”, “elderly and older”, and “women” in Pubmed, Scopus, and Google Scholar. The aim of this review is to summarize the management of early breast cancer in older women by discussing the controversies of screening in older women. Then, we try to define the optimal strategy for these women, either surgery alone or primary endocrine therapy. We also discuss the indications of lymph node dissection, and we evaluate the benefit of adjuvant radiotherapy, chemotherapy, and the anti HER2 treatment for these women.ResultsMore than 50% of patients with breast cancer are 65 years or older, and around 30% are more than 70 years old. Most randomized trials did not include older women. Hence, the treatment of breast cancer in older patients is based on the management provided to younger women. Regardless of age, the treatment must aim for the best efficiency. Advanced age in itself should not be a limitation to treatment. There are no standard guidelines set for elderly patients. Surgical treatment for older patients evolved to avoid mastectomy, and conservative mammary surgery was proposed, similar to that used in younger patients. The proportion of elderly patients receiving adjuvant radiotherapy is increasing. The role of adjuvant radiotherapy in older patients with breast cancer was analyzed. Adjuvant chemotherapy is beneficial to women with hormone receptor-negative tumors. In those with hormone receptor-positive tumors, adjuvant chemotherapy in association to trastuzumab is beneficial for HER2-positive tumors, and for women with HER2-negative tumors adjuvant hormonal therapy is a very good option.ConclusionBreast cancer is common in older women. This population requires particular and adapted management. It is essential for older patients to be included in new clinical trials for individualized treatment recommendation.

Histopathological Types of Operable Early Breast Cancer in the Elderly: Is there a Special Pattern? – a Retrospective, Multicentre Study

“…Advanced age is a known risk factor for the breast cancer. An increased risk for breast cancer is observed if the advanced age is associated with late first pregnancy, lack of breast feeding history, late menopause, use of HRT, smoking and obesity [1,12]. The average age at the time of breast cancer diagnosis is 61 years, and the majority of breast cancer related deaths occur at age of 65 years or older.…”

“…We analysed the histopathological diagnosis, grade of the tumour in the invasive ductal carcinoma, and presence of lympho-vascular invasion, which was reported as present or absent. 65 years or older [1,13]. There are reports that, with advanced age breast cancer may change its biological characteristics.…”

“…Increased risk for breast cancer is associated with late first pregnancy, lack of breast feeding history, late menopause, use of hormonal replacement therapy (HRT), smoking and obesity [1]. The median age of breast cancer diagnosis is 60 years old, and over 40% of new cases are diagnosed in women aged 65 years or older [2].…”

An observational study investigating failure of primary endocrine therapy for operable breast cancer in the elderly

“…However, no such model is yet widely available. Frailty and the burden of co-morbid disease increase with advancing age [1], as does the incidence of breast cancer [2]. Whilst surgery is the standard initial treatment of choice for early breast cancer [3], some elderly and frail patients with oestrogen receptor (ER) positive cancers who are considered too unfit for general anaesthesia, may be given primary endocrine therapy (PET) [4,5].…”

Determinação de mutaçães somáticas e germinativas em pacientes pós menopausadas com câncer de mama

“…Nos Estados Unidos, estimou-se a morte de cerca de 37 mil mulheres com câncer de mama, sendo a maioria (cerca de 22 mil) com mais de 65 anos (DeSantis et al, 2014). Neste grupo etário também ocorrem as maiores taxas de incidência e, com o envelhecimento da população, através da melhoria da qualidade de vida, esta doença se tornou um importante problema de saúde pública (Elomrani F et al, 2015). Segundo Diab et al (2000) o câncer de mama diagnosticado em mulheres idosas tem características próprias: maior incidência de tumores com expressão de receptores hormonais e, em comparação com pacientes jovens, tumores de baixo estadiamento e taxa de proliferação.…”