Necessity of Axillary Dissection in Elderly Women with Early Breast Cancer

Newlin, Matthew E.; Reiling, Richard B.; Nichols, Keith E.

doi:10.1007/s00268-002-6506-2

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…In older women with no palpable lymph nodes, forgoing lymph node dissection in early BC has almost no effect on OS, as shown by the low frequency of recurrence in the axillary lymph nodes [ 41 42 43 44 ]. Contrastingly, axillary lymph node dissection is recommended for patients with clinically positive nodes.…”

Section: Therapymentioning

confidence: 99%

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

et al. 2015

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Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.

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Section: Therapymentioning

confidence: 99%

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

et al. 2015

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“…Newlin et al reported similar findings in 378 patients over the age of 70 years, who had axillary dissection and concluded that the presence of lymph node metastasis did not appear to affect disease free survival rates significantly in elderly patients. 41 Recently, a randomised controlled trial comparing primary surgery with axillary clearance and primary surgery without axillary clearance in women aged 60 years and over (n 5 437; median age 74) reported similar disease free survival (DFS) and overall survival (OS) at a median follow-up of 6.6 years (6-year DFS, 67% v 66%; hazard ratio [HR]: 1.06; 95% CI, 0.79-1.42; p 5 0.69) and OS (6-year OS, 75% v 73%; HR: 1.05; 95% CI, 0.76-1.46; p 5 .77). All patients had clinically node negative disease and received adjuvant tamoxifen for 5 years.…”

Section: Surgical Managementmentioning

confidence: 99%

Management of early breast cancer in the elderly

Rao

Garimella

Hwang

et al. 2007

Intl Journal of Cancer

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Breast cancer is the most common malignancy in women with an age related increase in incidence ranging from 1 in 50 at age 50 to 1 in 10 at age 80. This is particularly significant in view of the changing demographics in the western population, characterised by an aging population and increased life expectancy. However in spite of favourable prognostic factors and less aggressive biological behaviour, elderly breast cancer patients receive less aggressive treatment when compared with their younger counterparts. Appropriate treatment should be offered depending on physiological reserve and comorbidities. Primary endocrine treatment has been shown to be associated with significant morbidity in terms of disease progression. Prompt surgery and adjuvant treatment can decrease relapse and improve survival. Radiation therapy is shown to decrease local relapse and chemotherapy may have a role in a select group of patients with adverse prognostic factors. With incidence of breast cancer bound to increase in the elderly population, it is essential to establish optimum therapy in this cohort of patients as studies reveal good outcome from standard treatment. ' 2007 Wiley-Liss, Inc.Key words: elderly breast cancer; primary endocrine treatment; conservative surgery; radiotherapy; chemotherapy Breast cancer is the most common malignancy in women and the incidence increases with age: 1 in 50 at age 50, 1 in 14 by age 70 and 1 in 9 by age 85. With changing demographics in the western hemisphere characterized by an aging population and increased life expectancy, the total incidence of breast cancer can be expected to increase with peak incidence occurring between 70 and 84 years.1 In the United States, women over the age of 65 have become a prominent cohort in the breast cancer population, with approximately 50% of all new breast cancers occurring in women aged 65 years and older and 25% occur after the age of 75 years.

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“…Several studies have reported lower use of ALND and postoperative radiotherapy in the elderly patient (Voogd et al, 1994;Guadagnoli et al, 1998a;Hebert-Croteau et al, 1999;Edge et al, 2002;Giordano et al, 2005). The benefit of ALND for elderly patients has been seriously questioned in the literature (Wazer et al, 1994;Newlin et al, 2002;Martelli et al, 2003) and surgeons may be reluctant to perform an additional ALND (following BCS or SNB) in elderly patients as they frequently suffer from comorbidity. Over the years 2001 -2002, in our study 50% of the patients who did not have an ALND had a tumour positive SNB; most of these patients were over 50 years of age.…”

Section: As Reference)mentioning

confidence: 99%

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

et al. 2005

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This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I -IIIA breast cancer patients diagnosed in 1989 -2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged X75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not have an ALND. Guideline compliance for BCS, with respect to radiotherapy and ALND, fell since the SNB introduction, from 96.1% before 2000 to 91.4% in 2002 (Po0.001). Noncompliance may however reflect patient-tailored medicine, as for elderly patients with small, radically resected primary tumours. The considerable variation in BCS-rates is more consistent with variations in surgeon preferences than patient's choice.

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Necessity of Axillary Dissection in Elderly Women with Early Breast Cancer

Cited by 10 publications

References 23 publications

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

Management of early breast cancer in the elderly

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

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