Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women

Abstract

BACKGROUNDPatients diagnosed with ductal carcinoma in situ (DCIS) at a young age appear to have a different natural history and biology, including a higher local relapse rate, than patients diagnosed later in life. The current study compared various pathologic and molecular features of DCIS arising in a cohort of young women with those of DCIS arising in a cohort of older women to identify potential biologic differences between these two populations of patients.METHODSThe study population consisted of 20 patients age < 42 years and 34 patients age > 60 years who were treated at Yale University School of Medicine with breast‐conserving therapy (BCT) and whose archival paraffin blocks were available and had sufficient tumor for staining. The original slides from each case were reviewed and the most representative specimen block from each case was processed for immunohistochemical staining. Pathologic characteristics evaluated for each case included histology, grade, and presence of necrosis. Paraffin‐embedded sections were immunohistochemically evaluated for expression of HER‐2/neu, estrogen receptor (ER), progesterone receptor (PR), bcl‐2, cyclin D1, Ki‐67, and p53.RESULTSAlthough there was no difference in pathologic features of the tumors between the two groups, HER‐2/neu was found to be overexpressed in a greater percentage of the younger population (P = 0.06). There was no apparent difference in expression of the other markers. Of note, HER‐2/neu expression was correlated with high nuclear grade (P = 0.004), necrosis (P = 0.06), and ER and PR negativity (P = 0.01 and P = 0.03, respectively) in the combined population.CONCLUSIONSThe current study data suggested that HER‐2/neu overexpression in younger patients may characterize a biologic difference in their tumor and may partially contribute to their higher risk of recurrence. Further studies are needed to assess whether this difference holds independent of grade and to evaluate the prognostic significance of HER‐2/neu overexpression in DCIS. Cancer 2003;97:1393–1403. © 2003 American Cancer Society.DOI 10.1002/cncr.11204

Bcl-2 and Ki-67 Expression in Young Women with Breast Cancer

“…A positive correlation was established between Bcl-2 expression and ER, PR expression, similiar to our study. In similiar studies concerning ductal carcinoma in situ (DCIS) cases, contrary to invasive ductal carcinoma, no differnce was determined between age groups and Bcl-2 expression [28]. Although many studies establish that Ki-67 proliferation index is higher in very young patients, we were not able to determine a similiar result in our study [29].…”

Correlation of Mammographic Calcifications with HER-2/neu Overexpression in Primary Breast Carcinomas

“…14, 15 Recently, Seo et al 16 reported that HER-2/neu overexpression in primary breast carcinoma was correlated with patients' age and calcifications at mammography. However, Likaki-Karatza et al 1 found that HER-2/neu positivity was statistically correlated to asymmetric density with poorly defined margins without calcifications in high-grade breast carcinomas.…”

Peculiaridades da radioterapia em idosos

“…In some cases, for example, it may be really appropriate to deprive the elderly patient of a treatment with clear curative indication due to the presence of multiple comorbidities (which on their turn would be responsible for the actual reduction in patient's life expectancy), but it is also an important conceptual error to directly correlate age per se with a smaller patient's tolerance to radiation treatment. Additionally, if by one hand some clinical studies suggest that, for selected patients, the age factor does not decrease tolerance to more aggressive treatments (10-13) , on the other hand the biological aggressiveness of tumors also seems to be variable in relation to the individual's age, being lower for some histological types, in older patients (14)(15)(16) .…”