Abstract
Introduction
Elderly breast cancer patients aged ≥75 years are underrepresented in most studies. Therefore, data on cancer characteristics, adjuvant treatment and survival in elderly patients are missing.
Patients and methods
In this retrospective study, we compared tumor characteristics and adjuvant therapy in 973 women with invasive, non-metastasized breast cancer aged ≥75 years with 3377 younger postmenopausal patients (50–74 years old). Time dynamics of tumor characteristics were investigated, comparing two observation periods between the years 2000–2004 versus 2005–2008.
Results
Compared to younger women, older patients were more often treated with mastectomy and less likely to receive adjuvant treatment. Although the overall survival rate increased over the observation period in both age groups, the older study group was characterized by shorter disease-free survival. Additionally, we observed an increase in about 1.65 years in the age at diagnosis as well as an increasing rate of breast-conserving surgery and sentinel lymph node biopsy for the whole study population between 2000 and 2008. Furthermore, we found a reduction in the proportion of estrogen receptor-positive tumors in the younger women and a decrease in G3-tumors in both age groups over the study time.
Conclusion
The older group’s reduced disease-free survival could be explained by the tumor characteristics and differences in the adjuvant treatment. Remarkably, elderly women are more likely to be overtreated surgically while being undertreated in terms of adjuvant therapy.
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References
AGO (2013) Aktuelle Empfehlungen zur Prävention, Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome: State of the Art 2013, 6th edn. Forschen, lehren, heilen, Zuckschwerdt, München
Bastiaannet E, Portielje JEA, van de Velde CJH et al (2011) Lack of survival gain for elderly women with breast cancer. Oncologist 16(4):415–423
Beadle BM, Woodward WA, Buchholz TA (2011) The impact of age on outcome in early-stage breast cancer. Semin Radiat Oncol 21(1):26–34
Chavez-MacGregor M, Zhang N, Buchholz TA et al (2013) Trastuzumab-related cardiotoxicity among older patients with breast cancer. J Clin Oncol 31(33):4222–4228
Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, Forbes JF (2010) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 11:1135–1141
Enger SM, Thwin SS, Buist DSM et al (2006) Breast cancer treatment of older women in integrated health care settings. J Clin Oncol 24(27):4377–4383
Ewijk RJG, Schwentner L, Wöckel A et al (2013) Trends in patient characteristics, treatment and survival in breast cancer in a non-selected retrospective clinical cohort study of 2,600 patients. Arch Gynecol Obstet 287(1):103–110
Garreau JR, Delamelena T, Walts D, Karamlou K, Johnson N (2006) Side effects of aromatase inhibitors versus tamoxifen: the patients’ perspective. Am J Surg 192:496–498
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(6):1302–1310
Giordano SH, Lin Y, Kuo YF et al (2012) Decline in the use of anthracyclines for breast cancer. J Clin Oncol 30(18):2232–2239
Hamaker ME, Bastiaannet E, Evers D et al (2013) Omission of surgery in elderly patients with early stage breast cancer. Eur J Cancer 49(3):545–552
Honma N, Sakamoto G, Akiyama F et al (2003) Breast carcinoma in women over the age of 85: distinct histological pattern and androgen, oestrogen, and progesterone receptor status. Histopathology 42(2):120–127
Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31(19):2382–2387
Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067
Muss HB (2010) Coming of age: breast cancer in seniors. Oncologist 15(Suppl 5):57–65
Mustacchi G, Cazzaniga ME, Pronzato P et al (2007) Breast cancer in elderly women: a different reality? results from the NORA study. Ann Oncol 18(6):991–996
Pappo I, Karni T, Sandbank J et al (2007) Breast cancer in the elderly: histological, hormonal and surgical characteristics. Breast 16(1):60–67
Rosenberg J, Chia YL, Plevritis S (2005) The effect of age, race, tumor size, tumor grade, and disease stage on invasive ductal breast cancer survival in the U.S. SEER database. Breast Cancer Res Treat 89(1):47–54
Rudenstam C, Zahrieh D, Forbes JF et al (2006) Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93. J Clin Oncol 24(3):337–344
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(12):2038–2045
Schoppmann SF, Bayer G, Aumayr K et al (2004) Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg 240(2):306–312
Schrodi S, Braisch U, Schenkirsch G et al (2013) Veränderungen der Therapie des Mammakarzinoms in Bayern seit Einführung des Mammografie-Screenings. Eine Analyse bayerischer Krebsregisterdaten der Jahre 2000 bis 2008. Gesundheitswesen
Statistische Ämter des Bundes und der Länder (2015) Demografischer Wandel in Deutschland, Heft 1, 2011: Bevölkerungs- und Haushaltsentwicklung im Bund und in den Ländern. https://www.destatis.de/DE/Publikationen/Thematisch/Bevoelkerung/DemografischerWandel/BevoelkerungsHaushaltsentwicklung5871101119004.pdf?__blob=publicationFile. Last accessed 13 July 2015
Statistisches Bundesamt (Destatis) (2015) Fachserie 12, Reihe 4 - Todesursachenstatistik 2010. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Todesursachen/Todesursachen2120400107004.pdf?__blob=publicationFile. Last accessed 13 July 2015
Wang J, Kollias J, Boult M et al (2010) Patterns of surgical treatment for women with breast cancer in relation to age. Breast J 16(1):60–65
Acknowledgments
We thank Elke Burger and all employees of the Magdeburg cancer registry who helped us with the collection, management and storage of the presented data. We especially thank all physicians who transmitted patient data into the Magdeburg cancer registry, enabling scientific use of this information.
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This article does not contain any studies with animals performed by any of the authors.
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Written informed consent was obtained from all patients before treatment. An additional individual consent for this analysis was not needed.
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Grumpelt, AM., Ignatov, A., Tchaikovski, S.N. et al. Tumor characteristics and therapy of elderly patients with breast cancer. J Cancer Res Clin Oncol 142, 1109–1116 (2016). https://doi.org/10.1007/s00432-015-2111-2
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DOI: https://doi.org/10.1007/s00432-015-2111-2