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Breast Cancer in the Elderly

  • Chapter
Oncologic Breast Surgery

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Breast cancer is the most common cancer in women in the world [1] with 1.15 million new cases per year, of which 361,000 (27.3% of cancer in women) are in Europe and 230,000 (31.3%) in North America [2]. Worldwide, nearly onethird of breast cancer cases occurs in patients over the age of 65 years old and in developed countries the proportion rises over 40% [3]. Studies have shown that around 50% of patients with breast cancer are those older than 65 years of age and 35% are older than 70 [4]. Age in itself is a significant risk of developing breast cancer [5] and most women who die of breast cancer are over the age of 65 [6]. Advances in breast cancer treatment have changed patients’ outcomes, particularly in developed world, and mortality rates have been decreased by approximately 30% in the last two decades [5–7]. Nevertheless, the applicability of these treatment advances in women over 65, and expecially over 70, often remains unclear. Older women are often underrepresented in clinical trials [8] and the extrapolation of data to this population can be difficult. It has been observed that elderly patients do not receive the standard treatment compared with their younger counterparts [9] and older patients tend to be undertreated in comparison with younger patients [10]. This undertreatment can have a strong negative effect on survival [11].

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References

  1. Althuis MD, Dozier JM, Anderson WF et al (2005) Global trends in breast cancer incidence and mortality 1973–1997. Int J Epidemiol 34:405–12

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics 2002. Ca: A Cancer J Clin 55:74–108

    Google Scholar 

  3. Ferlay J, Bray F, Pisani P et al (2004) Cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No. 5, version 2.0. Lyon: IARCPress GLOBOCAN

    Google Scholar 

  4. Holmes CE, Muss HB (2003) Diagnosis and treatment of breast cancer in the elderly. Ca: A Cancer J Clin 53:227–244

    Google Scholar 

  5. SEER database. SEER Stat Fact Sheets: Breast. Available http://seer.cancer.gov/statfacts/html/ breast.html, accessed January 6, 2010

    Google Scholar 

  6. Owusu C, Lash TL, Silliman RA (2007) Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women. Breast Canc Res Treat 102:227–236

    Article  Google Scholar 

  7. Canadian Cancer Society. Canadian Cancer Statistics 2009. Available at http://www.cancer.ca/Canadawide/About%20cancer/Types%20of%20cancer/Causes%20of%20 breast%20cancer.aspx?sc_lang=en, accessed January 5, 2010

    Google Scholar 

  8. Lewis JH, Kilgore ML, Goldman DP et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncology 21:1383–1389

    Article  Google Scholar 

  9. Hancke K, Denkinger MD, König J et al (2009) Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Onc 21:748–753

    Article  Google Scholar 

  10. Passage KJ, McCarthy NJ (2007) Critical review of the management of early-stage breast cancer in elderly women. Int Med J 37:181–189

    Article  CAS  Google Scholar 

  11. Bouchardy C, Rapiti E, Fioretta G et al (2003) Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 21:3580–5387

    Article  PubMed  Google Scholar 

  12. Rosso S, Gondos A, Zanetti R et al (2010) Up-to-date estimates of breast cancer survival for the years 2000-2004 in 11 European countries: the role of screening and a comparison with data from the United States. Eur J Cancer 46:3351–3335

    Article  PubMed  Google Scholar 

  13. Wildiers H, Kunkler I, Biganzoli L et al (2007) Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 8:1101–1115

    Article  PubMed  Google Scholar 

  14. Biganzoli L, Wildiers H, Oakman C et al (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13:148–160

    Article  Google Scholar 

  15. Arias E (2012) United States Life Tables, 2008. National Vital Statistics Reports, Centers for Disease Control and Prevention (CDC) 61:1–64

    Google Scholar 

  16. Schonberg MA, Marcantonio ER, Li D et al (2010) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28:2038–2045

    Article  PubMed Central  PubMed  Google Scholar 

  17. Gennari R, Curigliano G, Rotmensz N et al (2004) Breast carcinoma in elderly women-features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer 101:1302–1310

    Article  PubMed  Google Scholar 

  18. De Munck L, Schaapveld M, Siesling S et al (2011) Implementation of trastuzumab in conjunction with adjuvant chemotherapy in the treatment of non-metastatic breast cancer in the Netherlands. Breast Cancer Res Treat 129:229–233

    Article  CAS  PubMed  Google Scholar 

  19. Wildiers H, Van Calster B, van de Poll-Franse LV et al (2009) Relationship between age and axillary lymph node involvement in women with breast cancer. J Clin Oncol 27:2931–2937

    Article  PubMed  Google Scholar 

  20. Humphrey LL, Helfand M, Chan BK et al (2002) Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:347–360

    Article  PubMed  Google Scholar 

  21. Nystrom L, Andersson I, Bjurstam N et al (2002) Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 359:909–919

    Article  PubMed  Google Scholar 

  22. Galit W, Green MS, Lital KB (2007) Routine screening mammography in women older than 74 years: a review of the available data. Maturitas 57:109–119

    Article  PubMed  Google Scholar 

  23. Smith RA, Cokkinides V, Eyre HJ (2004) American Cancer Society guidelines for the early detection of cancer, 2004. Ca: A Cancer J Clin 54:41–52

    Google Scholar 

  24. Reed MWR, Audisio RA, Wyld L (2009) The role of surgery in the treatment of older women with breast cancer. Clin Oncol (R Coll Radiol) 21:103–110

    Article  CAS  Google Scholar 

  25. Laki F, Kirova YM, Savignoni A et al (2010) Management of operable invasive breast cancer in women over the age of 70: long-term results of a large-scale single institution experience. Ann Surg Oncol 17:1530–1538

    Article  PubMed  Google Scholar 

  26. Hind D, Wyld L, Beverley C et al (2006) Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev 1:CD004272

    Google Scholar 

  27. De Haes JCJM, Curran D, Aaronson NK et al (2003) Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomised clinical trial Eur J Cancer 39:945–951

    Article  PubMed  Google Scholar 

  28. Hurria A, Leung D, Trainor K et al (2003) Factors influencing treatment patterns of breast cancer patients age 75 and older. Crit Rev Oncol Hematol 46: 121–126

    Article  PubMed  Google Scholar 

  29. Norman SA, Localio AR, Potashnik SL et al (2009) Lymphedema in breast cancer survivors: Incidence, degree, time course, treatment, and symptoms. J Clin Oncol 27:390–397

    Article  PubMed Central  PubMed  Google Scholar 

  30. Mandelblatt JS, Edge SB, Meropol NJ et al (2003) Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol 21: 855–863

    Article  PubMed  Google Scholar 

  31. Martelli G, Boracchi P, De Palo M et al (2005) A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer-results after 5 years of follow-up. Ann Surg 242:1–6

    Article  PubMed Central  PubMed  Google Scholar 

  32. Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553

    Article  PubMed  Google Scholar 

  33. McMahon LE, Gray RJ, Pockaj BA (2005) Is breast cancer sentinel lymph node mapping valuable for patients in their seventies and beyond? Am J Surg 190:366–370

    Article  PubMed  Google Scholar 

  34. Lyman GH, Giuliano AE, Somerfield MR et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720

    Article  PubMed  Google Scholar 

  35. Huguenin P, Glanzmann C, Lutolf UM (1996) Acute toxicity of curative radiotherapy in elderly patients. Strahlenther Onkol 172:658–663

    CAS  PubMed  Google Scholar 

  36. Truong PT, Bernstein V, Lesperance M et al (2006) Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg 191:749–755

    Article  PubMed  Google Scholar 

  37. Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomized trials. Lancet 366:2087–2106

    Article  CAS  PubMed  Google Scholar 

  38. Truong PT, Lee J, Kader HA et al (2005) Locoregional recurrence risks in elderly breast cancer patients treated with mastectomy without adjuvant radiotherapy. Eur J Canc 41:1267–1277

    Article  Google Scholar 

  39. Ragaz J, Olivotto IA, Spinelli JJ et al (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial J Nat Canc Inst 97:116–126

    Article  Google Scholar 

  40. Wildiers H (2008) Challenges in treating older cancer patients: breast cancer. Ann Oncol 19:99–103

    Article  Google Scholar 

  41. Valassiadou K, Morgan DA, Robertson JF et al (2007) Successful management of elderly breast cancer patients treated without radiotherapy. W J Surg Oncol 5:62

    Article  Google Scholar 

  42. Recht A, Edge SB, Solin LJ et al (2001) Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1539–1569

    CAS  PubMed  Google Scholar 

  43. Whelan TJ, Pignol JP, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520

    Article  CAS  PubMed  Google Scholar 

  44. Kirova YM, Campana F, Savignoni A et al (2009) Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys 75:76–81

    Article  PubMed  Google Scholar 

  45. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomized trials. Lancet 365:1687–1717

    Article  Google Scholar 

  46. Hind D, Wyld L, Reed MW (2007) Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Canc 96:1025–1029

    Article  CAS  Google Scholar 

  47. Biganzoli L, Licitra S, Claudino W et al (2007) Clinical decision making in breast cancer: TAM and aromatase inhibitors for older patients-a jungle? Eur J Canc 43:2270–2278

    Article  CAS  Google Scholar 

  48. Macaskill EJ, Renshaw L, Dixon JM (2006) Neoadjuvant use of hormonal therapy in elderly patients with early or locally advanced hormone receptor-positive breast cancer. Oncologist 11:1081–1088

    Article  CAS  PubMed  Google Scholar 

  49. Crivellari D, Sun Z, Coates AS et al (2008) Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer: the BIG 1–98 trial. J Clin Oncol 26:1972–1979

    Article  CAS  PubMed  Google Scholar 

  50. Major P (2009) Preserving functional independence in elderly patients with cancer-associated bone disease: the role of zoledronic acid. Future Medicine 5:151–164

    CAS  Google Scholar 

  51. Perez EA, Suman VJ, Davidson NE et al (2008) Cardiac safety analysis of doxorubicin and cyclophosphamide followed by paclitaxel with or without Trastuzumab in the North Central Cancer Treatment Group N9831 adjuvant breast cancer trial. J Clin Oncol 26:1231–1238

    Article  CAS  PubMed  Google Scholar 

  52. Albain KS, Barlow WE, Shak S et al (2010) Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: A retrospective analysis of a randomised trial. Lancet Oncol 11:55–65

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Bastiaens H, Van Royen P, Pavlic DR et al (2007) Older people’s preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries. Patient Educ Couns 68:33–42

    Article  PubMed  Google Scholar 

  54. Cutuli B, Le-Nir CC, Serin D et al (2010) Male breast cancer. Evolutionof treatment and prognostic factors. Analysis of 489 cases. Crit Rev Oncol Hematol 73:246–254

    Article  CAS  PubMed  Google Scholar 

  55. Harlan LC, Zujewski JA, Goodman MT et al (2010) Breast cancer in men in the United States: a population-based study of diagnosis, treatment, and survival Cancer 116:3558–3568

    Article  PubMed Central  PubMed  Google Scholar 

  56. Korde LA, Zujewski JA, Kamin L et al (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28:2114–2122

    Article  PubMed Central  PubMed  Google Scholar 

  57. Giordano SH, Perkins GH, Broglio K et al (2005) Adjuvant systemic therapy for male breast carcinoma. Cancer 104:2359–2364

    Article  PubMed  Google Scholar 

  58. Walter LC, Brand RJ, Counsell SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285:2987–2994

    Article  CAS  PubMed  Google Scholar 

  59. Pallis AG, Wedding U, Lacombe D et al (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46:1019–1025

    Article  CAS  PubMed  Google Scholar 

  60. Pallis AG, Ring A, Fortpied C et al (2011) EORTC workshop on clinical trial methodology in older individuals with a diagnosis of solid tumors. Ann Onc 22:1922–1926

    Article  CAS  Google Scholar 

  61. Liu Y, Sanoff HK, Cho H et al (2009) Expression of p16INK4a in peripheral blood T-cells is a biomarker of human aging. Aging Cell 8:439–448

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Breast Unit, Fano Hospital, Fano (PU), Italy

    Guglielmo Miconi

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  1. Guglielmo Miconi
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Correspondence to Guglielmo Miconi .

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  1. Department of Surgery Breast Surgery Unit, Ospedali Riuniti University Hospital, Ancona, Italy

    Carlo Mariotti

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Miconi, G. (2014). Breast Cancer in the Elderly. In: Mariotti, C. (eds) Oncologic Breast Surgery. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-5438-7_11

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  • DOI: https://doi.org/10.1007/978-88-470-5438-7_11

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5437-0

  • Online ISBN: 978-88-470-5438-7

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