Advertisement

Clinical and Translational Oncology

, Volume 21, Issue 12, pp 1746–1753 | Cite as

Evolution of older patients diagnosed with early breast cancer in Spain between 1998 and 2001 included in El Alamo III project

  • Mª D. TorregrosaEmail author
  • M. J. Escudero
  • I. Paredero
  • E. Carrasco
  • B. Bermejo
  • J. Gavila
  • J. García-Saenz
  • A. Santaballa
  • P. Martínez
  • A. Llombart
  • R. Andrés
  • N. Batista
  • A. Fernández
  • A. Antón
  • M. Seguí
  • S. Gonzalez
  • A. Ruiz
  • On behalf of GEICAM, the Spanish Breast Cancer Group
Research Article
  • 33 Downloads

Abstract

Introduction

An increase in the number of cancer cases is expected in the near future. Breast cancer (BC) mortality rates increase with age even when adjusted for other variables. Here we analyzed BC disease-free survival (BCDFS) and BC specific survival (BCSS) in the El Alamo III BC registry of GEICAM Spanish Breast Cancer Group.

Materials and methods

El Alamo III is a retrospective registry of BC patients diagnosed between 1998 and 2001. Patients with stage I–III invasive BC of age groups 55–64 years (y), 70–74 years and ≥ 75 years were included. Patients and tumors characteristics, treatments and recurrences and deaths were analyzed.

Results

4343 patients were included within the following age intervals: 2288 (55–64 years), 960 (70–74 years), and 1095 (≥ 75 years). Older patients (≥ 70 years) were diagnosed with more advanced tumors (stage III) than younger patients (21.5% versus 13.4%, p < 0.0001). Mastectomies were performed more on older patients and they received less chemotherapy than younger patients (66.6% versus 43.1%, p < 0.00001 and 30.8% versus 71.6%, p < 0.0001, respectively). With a median follow-up of 5.9 years, 17.7% patients had BCDFS events in the younger group and 19.8% in the older group (p < 0.0001). A decrease in BCSS was also observed in older patients, either when analyzing patients ≥ 70y (p < 0.0001) and when differentiating by the two older groups (p < 0.0001).

Conclusions

Our study suggests that older BC patients have worse outcomes what can be a consequence of receiving inadequate adjuvant treatments. Specific trials for these patients are warranted to allow us to treat them with the same scientific rigor than younger patients.

Keywords

Older patients Early breast cancer Adjuvant treatment Survival Undertreatment 

Notes

Funding

This analysis has not received any external funding. All costs were covered by GEICAM, Spanish Breast Cancer Group. The original ALAMO III was funded by BMS, Roche, Lilly, Novartis, GSK and Pfizer.

Compliance with ethical standards

Conflict of interest

Dr García-Sáenz has received consultancy/speaker fees from Novartis, Celgene, Lilly, EISAI and Roche. Travel support from Novartis, Roche, Pfizer and his institution research funding from AstraZeneca. The rest of authors declared no conflicts of interest.

Ethical approval

Data were collected following the requirements of the Spanish legislation for privacy data protection in the considered period. The information collected by the investigators (doctors and health care personnel) was retrospective information that already existed in the patient’s clinical history. The information collected did not contain any personal data. The specific regulation for observational retrospective studies, like El Álamo, was developed in Spain at 2009 with the ORDER SAS/3470/2009, of December 16th, which publishes guidelines on post-authorization observational studies for drugs for human use. From this moment on, observational retrospective studies have a specific regulation that did not exist before. This is the reason why the IRBs in Spain did not reviewed nor approved any observational retrospective study before this legislation was developed.

Inform consent

According to regulations in force (Order SAS), the informed consent of the subjects is not required since: 1) in the process of data collection retrospectively, a secure dissociation procedure is adopted, ensuring that the information handled in the study does not contain personal data and 2) personal interviews are not required nor are biological samples collected from patients. Each patient received a number identification of participation in the study and patient’s data confidentiality and compliance with the ethical rules was guaranteed.

References

  1. 1.
    Estadística, I.N.d. Anuario Estadístico de España 2018. 2018. https://www.ine.es/prodyser/pubweb/anuarios_mnu.htm. Accessed 7 Nov 2018.
  2. 2.
    Galceran J, et al. Cancer incidence in Spain, 2015. Clin Transl Oncol. 2017;19(7):799–825.CrossRefGoogle Scholar
  3. 3.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Estimated cancer incidence, mortality and prevalence worldwide: GLOBOCAN 2012 v1.0. IARC CancerBase 2014, 11. ISBN-13 978-92-832-2447-1. IARC. https://publications.iarc.fr/Databases/Iarc-Cancerbases/GLOBOCAN-2012-Estimated-Cancer-Incidence-Mortality-And-Prevalence-Worldwide-In-2012-V1.0-2012. Accessed 20 Nov 2018.
  4. 4.
    van de Water W, et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307(6):590–7.PubMedGoogle Scholar
  5. 5.
    Schonberg MA, et al. Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol. 2011;29(12):1570–7.CrossRefGoogle Scholar
  6. 6.
    Vallet-Regi M, et al. Management of cancer in the older age person: an approach to complex medical decisions. Oncologist. 2017;22(3):335–42.CrossRefGoogle Scholar
  7. 7.
    Barcenas CH, et al. Risk of hospitalization according to chemotherapy regimen in early-stage breast cancer. J Clin Oncol. 2014;32(19):2010–7.CrossRefGoogle Scholar
  8. 8.
    Lichtman SM, et al. International Society of Geriatric Oncology Chemotherapy Taskforce: evaluation of chemotherapy in older patients—an analysis of the medical literature. J Clin Oncol. 2007;25(14):1832–43.CrossRefGoogle Scholar
  9. 9.
    Malik MK, Tartter PI, Belfer R. Undertreated breast cancer in the elderly. J Cancer Epidemiol. 2013;2013:893104.CrossRefGoogle Scholar
  10. 10.
    Ayodele O, et al. Comparing attitudes of younger and older patients towards cancer clinical trials. J Geriatr Oncol. 2016;7(3):162–8.CrossRefGoogle Scholar
  11. 11.
    Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004;22(22):4626–31.CrossRefGoogle Scholar
  12. 12.
    Clegg A, et al. Frailty in elderly people. Lancet. 2013;381(9868):752–62.CrossRefGoogle Scholar
  13. 13.
    Hurria A, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65.CrossRefGoogle Scholar
  14. 14.
    Mama GGEDIECD. Proyecto El Álamo III. Encuesta de evolución de pacientes con cáncer de mama en hospitales del grupo GEICAM (1998 –2001). 2014, Madrid: Comuniland S.L.Google Scholar
  15. 15.
    Bastiaannet E, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124(3):801–7.CrossRefGoogle Scholar
  16. 16.
    Siu AL, U.S. Preventive Services Task Force. Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2016;164(4):279–96.CrossRefGoogle Scholar
  17. 17.
    de Kruijf EM, et al. Comparison of frequencies and prognostic effect of molecular subtypes between young and elderly breast cancer patients. Mol Oncol. 2014;8(5):1014–25.CrossRefGoogle Scholar
  18. 18.
    Bouchardy C, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21(19):3580–7.CrossRefGoogle Scholar
  19. 19.
    Blair SRJ, Weiss A, Ward E, Unkart J. Treatment of breast cancer in women aged 80 and older: a systematic review. Breast Can Curr Res. 2016;1:115.Google Scholar
  20. 20.
    Muss HB, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med. 2009;360(20):2055–65.CrossRefGoogle Scholar
  21. 21.
    Freyer G, et al. Adjuvant docetaxel/cyclophosphamide in breast cancer patients over the age of 70: results of an observational study. Crit Rev Oncol Hematol. 2011;80(3):466–73.CrossRefGoogle Scholar
  22. 22.
    Chen HL, et al. Effect of age on breast cancer patient prognoses: a population-based study using the SEER 18 database. PLoS ONE. 2016;11(10):e0165409.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  • Mª D. Torregrosa
    • 1
    • 2
    Email author
  • M. J. Escudero
    • 2
  • I. Paredero
    • 1
  • E. Carrasco
    • 2
  • B. Bermejo
    • 2
    • 3
    • 4
  • J. Gavila
    • 2
    • 5
  • J. García-Saenz
    • 2
    • 4
    • 6
  • A. Santaballa
    • 2
    • 7
  • P. Martínez
    • 2
    • 8
  • A. Llombart
    • 2
    • 9
  • R. Andrés
    • 2
    • 10
  • N. Batista
    • 2
    • 11
  • A. Fernández
    • 2
    • 12
  • A. Antón
    • 2
    • 13
  • M. Seguí
    • 2
    • 14
  • S. Gonzalez
    • 2
    • 15
  • A. Ruiz
    • 2
    • 5
  • On behalf of GEICAM, the Spanish Breast Cancer Group
  1. 1.Medical Oncology DepartmentHospital Universitario Dr. PesetValenciaSpain
  2. 2.GEICAM, Spanish Breast Cancer GroupMadridSpain
  3. 3.Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universitat de ValenciaMadridSpain
  4. 4.Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIIIValenciaSpain
  5. 5.Instituto Valenciano de OncologíaValenciaSpain
  6. 6.Hospital Clínico Universitario San CarlosMadridSpain
  7. 7.Hospital Universitario La FeValenciaSpain
  8. 8.Hospital de BasurtoBilbaoSpain
  9. 9.Hospital Universitario de Lleida Arnau de VilanovaLleidaSpain
  10. 10.Hospital Universitario Lozano BlesaZaragozaSpain
  11. 11.Hospital Universitario de Canarias. Universidad de La LagunaLa LagunaSpain
  12. 12.Complejo Hospitalario de AlbaceteAlbaceteSpain
  13. 13.Hospital General Universitario Miguel ServetZaragozaSpain
  14. 14.Corporació Sanitaria Parc Taulli (Sabadell)BarcelonaSpain
  15. 15.Hospital Mutua de TerrassaBarcelonaSpain

Personalised recommendations