Breast cancer in women aged 75 years and older – tumour characteristics and treatment options

Abstract

Introduction: An optimal approach to older women with breast cancer is still a major challenge. In this paper, we present a retrospective analysis of treatment in patients aged 75 years and older who were treated at the Holycross Cancer Centre in 2015-2019. Material and methods: The analysed group consisted of 259 women. For estimation of the general status of patients, we used the Geriatric 8 questionnaire. For every patient, an individual treatment plan was established. Survival analysis was performed; disease-free survival (DFS), cancer-specific survival, and overall survival (OS) were calculated by the Kaplan-Meier method. For DFS and OS, the Cox proportional-hazard regression was applied. Results: The mean age in the analysed group was 80 years. Stage I and II cancer accounted for over 80% of patients. Radical mastectomy was performed in 56% and breast-conserving surgery in over 34% of patients. Sentinel lymph node biopsy was used in 114 patients. Preoperative systemic treatment was applied in 34 and postoperative chemotherapy in 51 patients, respectively. Trastuzumab was used in 23 patients. Postoperative hormonal therapy was applied in 205 and radiotherapy in 178 patients. During the observation after the treatment 32 patients died, while 227 survived. In multivariate analysis for DFS hormonotherapy was statistically significant for OS clinical stage and hormonotherapy. Conclusions: The treatment plan for older women consisted of surgery and radiation therapy, and systemic treatment should be always considered. The decision should be made by the breast cancer team.

Is the biology of breast cancer different in patients ≥ 80 years old?

“…In our study, we did not observe differences in ER and PR expression or median Ki67, and in the analysis of HER2 status, the differences were not significant, which is consistent with the results of other authors [15,16,21,23,24,26]. This resulted in a similar distribution of biological subtypes (according to St. Gallen) in the 80+ and < 80 groups, which is also consistent with data in the literature [22].…”

“…The percentage of histologic types other than NOS in patients 80+ reported in the literature ranges from 16% to 31.5% [5,16,17]. In our study, this was true for 24% of cancers in the 80+ group, which is consistent with literature data and confirms the increasing prevalence of rarer histologic types of breast cancer with age [18].…”

Frequency of use and characterization of frailty assessments in observational studies on older women with breast cancer: a systematic review

“…Eleven studies [ 42 , 73 , 86 , 93 , 98 , 105 , 120 , 121 , 144 , 154 , 155 ] (8.5% of 130 included studies) assessed frailty in their patient population, however only 4 studies [ 42 , 98 , 121 , 155 ] classified patients into fit, pre-frail, or frail categories. Frailty was only assessed at baseline and there were no studies which assessed frailty post-treatment.…”

“…A Balducci score of 2 (pre-frail) is assigned to an individual who has between one and two comorbidities and at most 1 geriatric syndrome. A Balducci score of 3 (frail) is assigned to an individual with 1 or more dependencies, more than 3 comorbidities, and more than 1 geriatric syndrome Demographic data and social status: Age; Comorbidities: Count; Functional status: ADL, IADL; Geriatric syndromes: Dementia, Falls, Delirium, Depression, Incontinence, Osteoporosis, Neglect and abuse, Failure to thrive 157 - - - B—R Kedzierawski 2021 [ 86 ] Geriatric 8 tool (frail/not frail) The Geriatric 8 screening tool is composed of 8 scored questions with a total score ranging from 0–17 where scores < 14 are low risk (not frail) and scores > 14 are high risk (frail) Demographic data and social status: Age; Functional status: Mobility, Self-health consideration; Cognition: Neuropsychological problems; Nutrition: BMI, Food intake, Weight loss; Polypharmacy: Prescription drug usage 259 - - - B—S; R; H; C; T Leo 2019 [ 93 ] Comprehensive Geriatric Assessment (NA) Undefined Functional status: ADL, IADL, ECOG-PS; Cognition: Total MMSE; Depression: GDS; Nutrition: Total MNA 50 - - - B—C; T Mandelblatt 2017 [ 98 ] Adapted Searle Deficits Accumulation Frailty Index (index) This adapted Searle Deficits Accumulation Frailty Index is composed of 35 assessed criteria, individually rated from 0 (no deficit), 0.5–0.75 (intermediate values of deficit), or 1 (deficit present). Values for non-missing items were summed, divided by the total number of non-missing items and standardized to yield a final score between zero and one, where a higher score indicates greater frailty.…”

Geriatric Breast Cancer: Staging, Molecular Surrogates, and Treatment. A Review & Meta-analysis

“…Breast cancer (BC) is the most frequent cancer among women, worldwide [ 2 ], while occurrence and death rates sharply rise with age [ 3 ]. Finding the best way to treat breast cancer in elderly women is still a challenge [ 4 ]. The annual number of new cases of BC in women is close to 2.3 million, accounting for over half of all cancer deaths in women in over 95% of countries [ 5 ].…”