Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

Abstract

Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥70 years), with most cases being oestrogen receptor-positive (ER+). Such tumours are often indolent and unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. This Review focuses on unique clinical considerations for screening, detection, and treatment regimens for older women who develop ER+ breast cancers—specifically, we focus on recent trends for de-implementation of screening, staging, surgery, and adjuvant therapies along the continuum of care. Additionally, we also review emerging basic and translational research that will further uncover the unique underlying biology of these tumours, which develop in the context of systemic age-related inflammation and changing hormone profiles. With prevailing trends of clinical de-implementation, new insights into mechanistic biology might provide an opportunity for precision medicine approaches to treat patients with well tolerated, low-toxicity agents to extend patients’ lives with a higher quality of life, prevent tumour recurrences, and reduce cancer-related burdens.

Bioinformatics Method Was Used to Analyze the Highly Expressed Gene FAM83A of Breast Cancer in Young Women

“…3Da theory isoelectric point pl = 6 61 ProtScale's Kyte and Doolittle method predicted the hydrophobicity of a protein, showing no significant hydrophobicity of the protein. PSORT H's K-NN method predicts that the probability of the protein being localized within the nucleus is 609% and the probability of locating the mitochondria is 26.1%, so it is likely to be an intranuclear protein ( Figure 6 ) [ 36 ].…”

Identifying Patterns and Barriers in OncotypeDX Recurrence Score Testing in Older Patients With Early-Stage, Estrogen Receptor–Positive Breast Cancer: Implications for Guidance and Reimbursement

“…Guidelines from multinational groups focused on the care of older cancer patients emphasize that treatment restrictions and limitations based on chronological age alone are not appropriate 24 and favor tailored treatment approaches among older patients with ER-positive BC so as to right-size care in light of tumor risk, comorbid conditions, and patient preferences. 27 Accordingly, the International Society of Geriatric Oncology and the European Society of Breast Cancer Specialists 24 note that adjuvant chemotherapy should not be contraindicated ab initio in women older than 65 years, but rather that the decision should be framed in a multidimensional, oncogeriatric approach and informed additionally by tools capable to anticipate the risk of treatment-emergent toxicities. 28,29 Among them, Cancer and Aging Research Group-Breast Cancer toll has been developed specifically for elderly patients with early BC.…”

Adoption and use of immunotherapy in breast cancer management in Africa: barriers and prospect – a narrative review

“…According to Carleton et al . 24 , to improve treatment for ER-positive BC patients, periodic screening, genetic screening, pathological determination of recurrence, radiation therapy, and breast surgery adjuvant endocrine therapy are clinical stages of treatment that should be implemented.…”