Association for Academic SurgeryOperation with less adjuvant therapy for elderly breast cancer
Introduction
Breast cancer is the most common malignant disease among women in the world. The incidence has been increasing substantially in Japan and other Asian countries over the past 3 decades, and it has a high incidence in the United States and Europe.1, 2, 3 In Asia including Japan, breast cancer incidence peaks among women in their 40s, whereas it peaks among women in their 60s in the United States and Europe.1, 4 Despite the difference in median age at diagnosis, the number of breast cancer patients is increasing in Japan due to a rapid increase in the number of elderly individuals. The population that is aged over 65 y accounted for 9.1% of the total in 1980, 19.9% in 2005, and it is estimated to reach 31.8% by the year 2030.5, 6
Although the number of elderly patients with breast cancer is increasing, knowledge about the possible differences in the biology and clinical outcomes of elderly cases of breast cancer that should reflect management according to age remains limited. Currently, treatment for elderly women with breast cancer is largely extrapolated from data derived from trials that enrolled younger patients; thus, the standard of care for elderly breast cancer patients is far from being established.7 Several reports demonstrated that elderly breast cancer patients are less likely to undergo surgery, radiation, or chemotherapy.8, 9, 10, 11 Although studies consistently show that older women are undertreated for breast cancer, the impact of undertreatment on breast cancer survival among older women remains controversial.10 Furthermore, little has been reported on the management of elderly breast cancer patients in Asian countries.
The aim of this study was to clarify the management of elderly breast cancer patients who underwent surgery and to investigate any effect of management choice on their outcomes.
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Patients and methods
The study included 2276 patients with breast cancer referred for surgery at Yokohama City University Medical Center between May 1993 and June 2014. Data on patient medical history, histopathologic factors of the breast cancers, and management including surgery, radiation, and systemic treatment (hormonal therapy or chemotherapy) were recorded. This study was approved by the Institutional Review Board of Yokohama City University, Kanagawa, Japan.
Estrogen receptor (ER) level, progesterone
Pathologic characteristics by age group
Of the 2276 women in our study population, 1632 (71.7%) were aged below 64 y (young), 400 (17.6%) were between 65 and 74 y (older), and 244 (10.7%) were aged older than 75 y (elderly). The patients' characteristics are summarized in Table 1. The elderly patients had larger and more advanced tumors, but no significant difference was observed among groups in terms of lymph node involvement. Because of the increased frequency of larger tumors, the elderly patients had significantly advanced stage
Discussion
The elderly patients (older than 75 y) in our cohort had more advanced disease (stages III and IV), which is consistent with other studies.8, 23 This is partially explained by the delay in diagnosis because fewer elderly patients undergo screening mammograms.24 Wan et al.25 reported that the distribution of breast cancer subtypes varies by race and/or ethnicity, and subtype plays an important role in the biology of breast cancer. Breast cancers arising in elderly women have less ER expression
Conclusion
In conclusion, our study showed that local and systemic therapies were administered less frequency to elderly patients, aged ≥75 y than younger patients. Locoregional recurrence–free survival was worse in elderly patients, but survival was not affected. The findings of this observational study could represent the outcomes of different management choices in the elderly population. We need to consider the variety of elderly patients' characteristics when developing guidelines for personalized
Acknowledgment
The authors thank Dr Shoko Adachi, Dr Fumi Harada, Dr Hidetaka Shima, Dr Kumiko Kida, Dr Shinya Yamamoto, and Dr Kazuhiro Shimada for collecting clinicopathological data. They also thank Dr Mikiko Tanabe for pathologic opinions. K.T. is supported by NIH/NCI grant R01CA160688 and Susan G. Komen Investigator Initiated Research Grant IIR12222224.
Authors' contributions: A.Y., K.N., S.S., and D.S. conceptualized and collected data described in the article. A.Y., K.T., and T.I. prepared and revised
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Cited by (9)
A population-based study of treatment patterns, 10-year recurrence and breast cancer-specific mortality in a cohort of elderly patients with breast cancer
2021, American Journal of SurgeryCitation Excerpt :Schonberg (2010) found that mastectomy was the most common treatment for women 80–84 years of age with stage I-II disease while very elderly women (≥85 years) more often received BCS alone.8 We also found that older women were less likely to have re-excision of positive margins after BCS and less likely to undergo axillary staging, including SLNB and ALND, results also reported by others.6,7,10,19,27,28 Higher mastectomy rates in elderly patients may be a reflection of physician recommendations, patient’s choice (e.g., avoidance of radiotherapy due to toxicity or burden of daily treatment visits), or elderly patients presenting more often with larger tumours requiring mastectomy 8,15,29.
Survival Outcome and Predictors of Survival in Elderly Breast Cancer Patients following Curative Treatment
2023, South Asian Journal of CancerOlder breast cancer undertreatment: Unconscious bias to undertreat-potential role for the international geriatric radiotherapy group?
2020, Translational Cancer Research