DOI QR코드

DOI QR Code

Breast Cancer at Extreme Ages - a Comparative Analysis in Chile

  • Acevedo, Francisco (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Camus, Mauricio (Department of Surgery, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Sanchez, Cesar (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile)
  • Published : 2015.03.09

Abstract

Background: Young onset breast cancer (BC) has a worse outcome as compared to in the elderly. However, some studies have shown that BC in the elderly, despite indolent features, does also cause increase in mortality. In an attempt to compare clinic-pathological characteristics, BC subtypes and survival in patients with BC presenting at extremes of age, we performed a retrospective study. Materials and Methods: Patients were either ${\leq}40$ or ${\geq}70$ years old. Subtypes were defined using immunohistochemistry and histological grade. Chi-Square test was used for evaluation of categorical variables, and Kaplan-meier and log-rank for disease-specific survival (DSS) and disease free survival (DFS). Results: We analyzed 256 patients ${\leq}40$ and 366 patients ${\geq}70$. Younger patients presented with more aggressive disease, with less luminal A but more luminal B and triple negative (TN) subtype. With a median follow-up of 57.5 months, DFS at 5 years in younger patients was 72.3% vs 84.6% in the elderly (p=0.007). Luminal A and B disease presented with worse DFS in younger patients. The opposite was seen in the TN subgroup. Although we found no significant differences in DSS, older patients with TN tumors died of BC more frequently. This group also received less chemotherapy. Conclusions: Young patients present with more aggressive disease, this translating into worse DFS. However, elderly patients with TN disease represent a particular subpopulation with worse DFS and DSS, suggesting that chemotherapy should not be withheld only because of age.

Keywords

Breast neoplasm;age of onset;aged;young onset;premenopause;chemotherapy

References

  1. Aapro M, Wildiers H (2012). Triple-negative breast cancer in the older population. Ann Oncol, 23, 52-5. https://doi.org/10.1093/annonc/mds347
  2. Acevedo F, Sanchez C, Jans J, et al (2014). How much survival benefit is necessary for breast cancer patients to opt for adjuvant chemotherapy? results from a Chilean survey. Ecancermedicalscience, 8, 391.
  3. Adami H, Malker B, Meirik O, et al (1985). Age as a prognostic factor in breast cancer. Cancer, 56, 898-902. https://doi.org/10.1002/1097-0142(19850815)56:4<898::AID-CNCR2820560433>3.0.CO;2-L
  4. Anders C, Johnson R, Litton J, et al (2009). Breast cancer before age 40 years. Sem Oncol, 36, 237-49. https://doi.org/10.1053/j.seminoncol.2009.03.001
  5. Bastiaannet E, Liefers G , de Craen J, et al (2010). 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 Treatment, 124, 801-7. https://doi.org/10.1007/s10549-010-0898-8
  6. Bastiaannet E, Portielje J, van de Velde C, et al (2011). Lack of survival gain for elderly women with breast cancer. Oncologist, 16, 415-23. https://doi.org/10.1634/theoncologist.2010-0234
  7. Berry D, Cronin K, Plevritis S, et al (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med, 353, 1784-92. https://doi.org/10.1056/NEJMoa050518
  8. 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, 148-60. https://doi.org/10.1016/S1470-2045(11)70383-7
  9. Bouchardy C, Rapiti E, Fioretta G, et al (2003). Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol, 21, 3580-7. https://doi.org/10.1200/JCO.2003.02.046
  10. Champion V. (1992). Breast self-examination in women 65 and older. J Gerontol, 47, 75-9. https://doi.org/10.1093/geronj/47.2.P75
  11. Cianfrocca M, Goldstein L (2004). Prognostic and predictive factors in early-stage breast cancer. Oncology, 9, 606-16. https://doi.org/10.1634/theoncologist.9-6-606
  12. Colak D, Nofal A, Albakheet A, et al (2013). Age-specific gene expression signatures for breast tumors and cross-species conserved potential cancer progression markers in young women. PloS One, 8, 63204. https://doi.org/10.1371/journal.pone.0063204
  13. Diab S, Elledge R, Clark G (2001). Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst, 93, 65-6.
  14. Elkin E, Hurria A, Mitra N, et al (2006). Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol, 24, 2757-64. https://doi.org/10.1200/JCO.2005.03.6053
  15. Elston C, Ellis I (1991). Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow up. Histopathology, 19, 403-10. https://doi.org/10.1111/j.1365-2559.1991.tb00229.x
  16. Fisher C, Egan M, Smith P, et al (1997). Histopathology of breast cancer in relation to age. Br J Cancer, 75, 593-6. https://doi.org/10.1038/bjc.1997.103
  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 postmenopasual patients. Cancer, 101, 1302-10. https://doi.org/10.1002/cncr.20535
  18. Gnerlich J, Deshpande A, Jeffe D, et al (2009). Elevated breast cancer mortality in young women (<40 Years) compared with older women is attributed to poorer survival in early stage disease. J Am College Surgeons, 208, 341-7. https://doi.org/10.1016/j.jamcollsurg.2008.12.001
  19. Goldhirsch A, Ingle J, Gelber R, et al (2009). Thresholds for therapies: highlights of the St gallen international expert consensus on the primary therapy of early breast cancer 2009. Ann Oncol, 20, 1319-29. https://doi.org/10.1093/annonc/mdp322
  20. Goldhirsch A, Winer E, Coates S, et al (2013). Personalizing the treatment of women with early breast cancer: highlights of the St gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann Oncol, 24, 2206-23. https://doi.org/10.1093/annonc/mdt303
  21. Goldhirsch A, Wood W, Gelber R, et al (2007). Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol: Official J European Soc Med Oncol/ESMO, 18, 1133-44. https://doi.org/10.1093/annonc/mdm271
  22. Hanson L, Muss H (2010). Cancer in the oldest old: making better treatment decisions. J Clin Oncol: Official J Am Soc Clin Oncol, 28, 1975-6. https://doi.org/10.1200/JCO.2009.27.6022
  23. Kissal A, Beser A (2011). Knowledge , facilitators and perceived barriers for early detection of breast cancer among elderly Turkish women. Asian Pac J Cancer Prev, 12, 975-84.
  24. Kroman N, Jensen M, Wohlfahrt J, et al (2000). Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ (Clin Res Ed.), 320, 474-8. https://doi.org/10.1136/bmj.320.7233.474
  25. Louwman W, Vulto J, Verhoeven R, et al (2007). Clinical epidemiology of breast cancer in the elderly. European J Cancer (Oxford, England: 1990), 43, 2242-52. https://doi.org/10.1016/j.ejca.2007.08.005
  26. Memon Z, Shaikh A, Rizwan S, et al (2013). Reasons for patient's delay in diagnosis of breast carcinoma in Pakistan. Asian Pac J Cancer Prev, 14, 7409-14. https://doi.org/10.7314/APJCP.2013.14.12.7409
  27. Morrison D, Rahardja D, King E, et al (2012). Tumour biomarker expression relative to age and molecular subtypes of invasive breast cancer. British J Cancer, 107, 382-7. https://doi.org/10.1038/bjc.2012.219
  28. Morrow M (1994). Breast disease in elderly women. Surg Clinic North Am, 74, 145-61. https://doi.org/10.1016/S0039-6109(16)46233-X
  29. Nixon J, Neuberg D, Hayes D, et al (1994). Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol: Official J Am Soc Clin Oncol, 12, 888-94. https://doi.org/10.1200/JCO.1994.12.5.888
  30. Oran E, Yankol Y, Soybir G, et al (2014). Distinct postsurgical management in young and elderly breast cancer patients results in equal survival rates. Asian Pac J Cancer Prev, 15, 7843-7. https://doi.org/10.7314/APJCP.2014.15.18.7843
  31. Ring A, Harder H, Langridge C, et al (2013). Adjuvant chemotherapy in elderly women with breast cancer (AChEW): an observational study identifying MDT perceptions and barriers to decision making. Ann Oncol, 24, 1211-9. https://doi.org/10.1093/annonc/mds642
  32. Roder D, Silva P, Zorbas H, et al (2012). Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand. Asian Pac J Cancer Prev, 13, 1675-82. https://doi.org/10.7314/APJCP.2012.13.4.1675
  33. Schonberg M, Marcantonio E, Li D, et al (2010). Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol, 28, 2038-45. https://doi.org/10.1200/JCO.2009.25.9796
  34. Siegel R, Ma J, Zou Z, et al (2014). Cancer Statistics, 2014, 64, 9-29. https://doi.org/10.3322/caac.21208
  35. Singh R, Hellman S, Heimann R (2004). The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer, 100, 1807-13. https://doi.org/10.1002/cncr.20206
  36. U.S. Preventive Services Task Force. (2009). Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med, 151, 716-26. https://doi.org/10.7326/0003-4819-151-10-200911170-00008
  37. Van Leeuwen B, Rosenkranz K, Feng L, et al (2011). The effect of under-treatment of breast cancer in women 80 years of age and older. Crit Rev Oncol/hematol, 79, 315-20. https://doi.org/10.1016/j.critrevonc.2010.05.010
  38. Vinh-Hung V, Joseph S, Coutty N, et al (2010). Age and axillary lymph node ratio in postmenopausal women with T1-T2 node positive breast cancer. Oncolog, 15, 1050-62. https://doi.org/10.1634/theoncologist.2010-0044
  39. Vollmer R (1996). Younger women with breast carcinoma have a poorer prognosis than older women. Cancer, 78, 1518-9. https://doi.org/10.1002/(SICI)1097-0142(19961001)78:7<1518::AID-CNCR24>3.0.CO;2-1
  40. Wei X-Q, Li X, Xin X-J,et al (2013). Clinical features and survival analysis of very young (age<35) breast cancer patients. Asian Pac J Cancer Prev, 14, 5949-52. https://doi.org/10.7314/APJCP.2013.14.10.5949
  41. Weiss A, Noorbaksh A, Tokin C, et al (2013). Hormone receptornegative breast cancer: undertreatment of patients over 80. Ann Surg Oncol, 20, 3274-8. https://doi.org/10.1245/s10434-013-3115-2
  42. Yoshida M, Shimizu C, Fukutomi T, et al (2011). Prognostic factors in young Japanese women with breast cancer : prognostic value of age at diagnosis. Jpn J Clin Oncol, 41, 180-9. https://doi.org/10.1093/jjco/hyq191

Cited by

  1. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review pp.1573-7217, 2017, https://doi.org/10.1007/s10549-017-4448-5