Biology of primary breast cancer in older women beyond routine biomarkers

Abstract

Purpose There are numerous biomarkers which may have potential predictive and prognostic significance in breast cancer. This is extremely important in older adults, who may opt for less aggressive therapy. This work outlines the literature on biological assessment outside of standard biomarkers (defined as ER, PgR, HER2, Ki67) in women ≥ 65 years with primary operable invasive breast cancer, to determine which additional biomarkers are relevant to outcome in older women. Methods Medline and Embase databases were searched. Studies were eligible if included ≥ 50 patients aged ≥ 65 years; stratified results by age; measured a biomarker outside of standard assay and reported patient data. Results A total of 12 studies were appraised involving 5000 patients, measuring 28 biomarkers. The studies were extremely varied in methodology and outcome but three themes emerged: 1. Differences in biomarker expression between younger and older women, indicating that breast cancer in older women is generally less aggressive compared to younger women; 2. Relationship of biomarker expression with survival, suggesting biomarkers which may exclusively predict response to primary treatment in older women; 3. Association of biomarker with chemotherapy, suggesting that older patients should not be declined chemotherapy based on age alone. Conclusion There is evidence to support further investigation of B-cell lymphoma (BCL2), liver kinase (LK)B1, epidermal growth factor receptor (EGFR), cytoplasmic cyclin-E, mucin (MUC)1 and cytokeratins (CKs) as potential predictive or prognostic markers in older women with breast cancer undergoing surgery. Studies exploring these biomarkers in larger cohorts and in women undergoing non-operative therapies are required.

Comparison of Ki67 Index Measurements in Breast Cancer with Manual and Digital Methods

“…Çalışmada tüm metotlarla ölçülmüş Ki67 değerlerinin yaş ile negatif korelasyonu, meme kanserinin yaşlıda daha az agresif seyri ve gençlerde daha az tümör diferansiyasyonu ve daha yüksek Ki67 değerleri gözlenmesine dair kanıtlara paraleldir 8,9 . Tüm metotlarla saptanmış Ki67 değerlerinin histolojik derece ile iyi düzeydeki pozitif korelasyonu histolojik dereceleme için kullanılan üç parametreden birinin, Ki67 gibi hücre çoğalmasını gösteren mitoz sayısı olmasına atfedilebilir 10 .…”