Meeting Report: Breast Cancer in the Older Woman

Martoni, Andrea; Cucinotta, Domenico; Balducci, Lodovico

doi:10.1177/030089160409000416

Cited by 2 publications

(4 citation statements)

References 62 publications

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“…Finally, the CGA allows recognition of frailty, a condition in which most functional reserve is exhausted and the aim of treatment is palliation. Frailty is frequent between age 70-85 when most breast cancers occur, is considered irreversible, and involves negligible functional reserve and minimal tolerance to stress [14][15][16].…”

Section: Special Considerations In Clinical Deci-sion Making In the Ementioning

confidence: 99%

“…Currently, partial and even total mastectomy can be performed under local anesthesia with negligible morbidity [34]. In view of the worse outcome and the negligible morbidity of mastectomy in older women, standard of practice has not favored primary tamoxifen treatment except in exceptionally frail patients or those with a significant reduction in life expectancy, or if the patient refuses surgery [16].…”

Section: Surgerymentioning

confidence: 99%

“…Two issues should be considered when analyzing chemotherapy data in elderly patients: older patients received inadequate doses of chemotherapy, or chemotherapy lost its effectiveness with age [16]. The first possibility has been well documented in several studies: age has been associated with reduced tolerance to adjuvant chemotherapy, with a consequent reduction in dose intensity [76][77][78].…”

Section: Chemotherapymentioning

confidence: 99%

“…Women in this age group were included in only a few trials and always in a proportion much lower than the prevalence of cancer in that age group [8]. Most trials of adjuvant chemotherapy conducted in postmenopausal women with involved axillary lymph nodes had an upper age limit, ranging from 59 to 87 years [16]. In these trials, which are extremely heterogeneous for patients characteristics, age limits and for treatment regimens used, virtually all forms of adjuvant chemotherapy reduced the recurrence rate of breast cancer.…”

Section: Chemotherapymentioning

confidence: 99%

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Adjuvant Therapy in Elderly Patients with Early Breast Cancer

Dellapasqua

Balduzzi

Goldhirsch

et al. 2006

CCTR

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Approximately 50% of new breast cancers occur in women aged 65 and older, and the incidence and prevalence of breast cancer among older women are expected to increase in the future. Moreover, in the past years, life expectancy has increased exceeding 10 years in patients aged 75 years. Aging is associated with a decline in the functional reserve of multiple organ systems, an increase in the prevalence of functional dependence, comorbidity and memory disorders, and a decline in economic resources and social support. All these aspects should be evaluated using some form of geriatric assessment, to rule out unsuspected conditions that may interfere with cancer treatment. Even if the course of breast cancer is more indolent in older than in younger women, up to 20% of women older than 70 years of age have aggressive hormone-receptor-poor tumors.Adequate surgical resection is the mainstay treatment for primary breast cancer even in older women. Lymph node dissection remains a major component of staging and local control, however owing to the sentinel lymph node technique, only women whose sentinel lymph node is invaded by the tumor do need full dissection. Radiation therapy reduces the recurrence rate for any category of tumors, including those occurring in older individuals.Adjuvant hormonal therapy should be recommended to women whose breast tumors contain hormone receptors, regardless of age, involvement of axillary nodes or tumor size. Tamoxifen is the most commonly used hormonal therapy, with data supporting one to five-year course of treatment in elderly patients. Recent results from trials comparing tamoxifen to aromatase inhibitors (anastrozole, letrozole and exemestane), given at different time points, have reported superior results of these drugs over tamoxifen in terms of disease-free survival but not of survival. Aromatase inhibitors can be considered for elderly women according to the degree of risk and biological features, and in those with contraindications to tamoxifen.As reported in the 2005 Early Breast Cancer Trialists Collaborative Group (EBCTCG) analysis, trials of adjuvant chemotherapy involved few women older than 70 years of age to be reliably informative as to whether it confers any survival benefit in this age group. For patients with hormone receptor negative tumors few specific published data are until now available, partly because these tumors represent a small subset in adjuvant studies in the elderly, and also because the distinction between ER poor and ER negative tumors is still a matter of controversy. It would be advisable to participate in currently open clinical trials that are addressing this issue.There is reluctance to prescribe systemic treatments due to the complexity of evaluation for these patients. Taking into account the limited amount of data and uncertainty regarding optimal treatment, individualized care on the basis of biologic characteristics, comorbidity, social support, functional status, and patient preferences should be considered. Trials of tailored adjuvant ther...

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Section: Special Considerations In Clinical Deci-sion Making In the Ementioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

Section: Chemotherapymentioning

confidence: 99%

Section: Chemotherapymentioning

confidence: 99%

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Adjuvant Therapy in Elderly Patients with Early Breast Cancer

Dellapasqua

Balduzzi

Goldhirsch

et al. 2006

CCTR

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Locally Advanced Breast Cancer in the Elderly: Curettage Mastectomy

Solej

Ferronato

Nano

2005

Tumori

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Aims and background Locally advanced breast tumor represents 5–20% of new cases diagnosed every year. The purpose of this study was to report our experience and to compare it with the literature. Methods From 1998 to 2003 at the Molinette Hospital in the Turin University Third Division of General Surgery, there were 34 cases of breast cancer in older women (between 70 and 94 years of age), 14 of which (41.18%) were locally advanced breast tumor. We evaluated the type of surgical intervention and anesthesia used, muscular invasion, the presence of receptors positive to estrogens and progesterone, the operative mortality, the percentage of local-regional recurrence, and relapses after a period of time. Results Among the patients with locally advanced breast tumor, 21.43% (3/14) were at stage MIA and 78.57% (11/14) at stage IIIB. In 14.29% (2/14) of the cases, Patey's radical mastectomy was performed, in 57.14% (8/14) Halsted's radical mastectomy, and in 28.57% (4/14) a simple mastectomy with the removal of the fascia of the major pectoral muscle. Three (21.43%) patients underwent a second intervention for local-regional disease. None of the patients had distant metastasis in the first 2 years after the operation. Mortality after 2 years was 23.1% (3/13). None of the patients who underwent surgery had adjuvant therapy, usually because it was refused by the patients themselves or their families. All the negative and positive hormone receptor patients received tamoxifen. Conclusions Locally advanced breast tumors are frequent in elderly women. In the past, there has been a tendency to surgical under-treatment. As regards locally advanced breast tumor, curettage operations represent the only possibility to improve the quality of life of the elderly. These should be performed after carefully evaluating a series of variables in the general and local condition of the patient, the aggressiveness of the intervention and the life expectancy.

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Meeting Report: Breast Cancer in the Older Woman

Cited by 2 publications

References 62 publications

Adjuvant Therapy in Elderly Patients with Early Breast Cancer

Adjuvant Therapy in Elderly Patients with Early Breast Cancer

Locally Advanced Breast Cancer in the Elderly: Curettage Mastectomy

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