Advertisement

Tumor characteristics and therapy of elderly patients with breast cancer

  • A.-M. Grumpelt
  • A. Ignatov
  • S. N. Tchaikovski
  • E. Burger
  • S.-D. Costa
  • H. EggemannEmail author
Original Article – Clinical Oncology

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.

Keywords

Breast cancer Elderly patients Adjuvant treatment 

Notes

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.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Written informed consent was obtained from all patients before treatment. An additional individual consent for this analysis was not needed.

References

  1. AGO (2013) Aktuelle Empfehlungen zur Prävention, Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome: State of the Art 2013, 6th edn. Forschen, lehren, heilen, Zuckschwerdt, MünchenGoogle Scholar
  2. Bastiaannet E, Portielje JEA, van de Velde CJH et al (2011) Lack of survival gain for elderly women with breast cancer. Oncologist 16(4):415–423CrossRefPubMedPubMedCentralGoogle Scholar
  3. Beadle BM, Woodward WA, Buchholz TA (2011) The impact of age on outcome in early-stage breast cancer. Semin Radiat Oncol 21(1):26–34CrossRefPubMedPubMedCentralGoogle Scholar
  4. Chavez-MacGregor M, Zhang N, Buchholz TA et al (2013) Trastuzumab-related cardiotoxicity among older patients with breast cancer. J Clin Oncol 31(33):4222–4228CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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 11:1135–1141CrossRefPubMedGoogle Scholar
  6. 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):4377–4383CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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):103–110CrossRefPubMedGoogle Scholar
  8. Garreau JR, Delamelena T, Walts D, Karamlou K, Johnson N (2006) Side effects of aromatase inhibitors versus tamoxifen: the patients’ perspective. Am J Surg 192:496–498CrossRefPubMedGoogle Scholar
  9. 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):1302–1310CrossRefPubMedGoogle Scholar
  10. Giordano SH, Lin Y, Kuo YF et al (2012) Decline in the use of anthracyclines for breast cancer. J Clin Oncol 30(18):2232–2239CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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):545–552CrossRefPubMedGoogle Scholar
  12. 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):120–127CrossRefPubMedGoogle Scholar
  13. 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):2382–2387CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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):2061–2067CrossRefPubMedGoogle Scholar
  15. Muss HB (2010) Coming of age: breast cancer in seniors. Oncologist 15(Suppl 5):57–65CrossRefPubMedGoogle Scholar
  16. 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):991–996CrossRefPubMedGoogle Scholar
  17. Pappo I, Karni T, Sandbank J et al (2007) Breast cancer in the elderly: histological, hormonal and surgical characteristics. Breast 16(1):60–67CrossRefPubMedGoogle Scholar
  18. 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):47–54CrossRefPubMedGoogle Scholar
  19. 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):337–344CrossRefPubMedGoogle Scholar
  20. 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):2038–2045CrossRefPubMedPubMedCentralGoogle Scholar
  21. Schoppmann SF, Bayer G, Aumayr K et al (2004) Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg 240(2):306–312CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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. GesundheitswesenGoogle Scholar
  23. 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
  24. 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
  25. 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):60–65CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • A.-M. Grumpelt
    • 1
  • A. Ignatov
    • 1
  • S. N. Tchaikovski
    • 2
  • E. Burger
    • 3
  • S.-D. Costa
    • 1
  • H. Eggemann
    • 1
    Email author
  1. 1.University Womens HospitalOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.University Womens HospitalRWTH Aachen UniversityAachenGermany
  3. 3.Cancer Registry MagdeburgMagdeburgGermany

Personalised recommendations