Prognostic factors in elderly patients with breast cancer

Abstract

BackgroundBreast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more.The study was aimed to investigate specific predictive factors for elderly patients so to select the best way to treat and follow these patients.MethodsA search was performed on Medline, Embase, Scopus using the following Key words: Breast cancer, Breast neoplasms, Aged, Elder, Elderly, Eldest, Older, Survival analysis, Prognosis, Prognostic factors, Tumor markers, Biomarkers, Comorbidity, Geriatric assessment, Axilla, Axillary surgery. 3029 studies have been retrieved. Paper in which overall or disease free survival were not end points, or age class was not well defined, or the sample was too small, were excluded. At last 42 papers fulfilled the criteria.Results and discussionLack of screening and delay in diagnosis may be responsible for the minor improvement in survival observed in elderly respect to younger breast cancer patients. Predictive factors are the same and must be assessed with the same attention reserved to younger women.ConclusionsMost of elderly patient are fit to undergo standard treatment and can get the same benefits of younger women. Nevertheless it is possible that some older women with early breast cancer can be spared too aggressive treatments. Geriatric assessment and co-morbidities can affect the prognosis modifying surveillance, life expectancy and compliance to therapies. They can thus be useful to select the better treatment, either surgical or radio or hormone - or chemo-therapy.

Factors influencing breast cancer outcomes in Australia: A systematic review

“…These groups of women are more likely to present with poorer tumour characteristics due to delays in diagnosis (Baade et al, ; Clayforth et al, ; Kok et al, ; Moore et al, ; Roder et al, ). Possible explanations for this include lack of knowledge of breast cancer symptoms and importance of screening, differing health or cultural beliefs, lack of access to screening services or appropriate medical services (Cappellani et al, ; Javid et al, ; Kolahdooz et al, ; Roder, Webster et al, ; Whop et al, ). These barriers need to be explored and addressed so that evidence‐based interventions can be implemented to reduce the risk of breast cancer mortality among these groups of women.…”

Expression of D2-40 in Benign and Malignant Breast Lesions and Study the Correlation between Lymphovascular Density and other Prognostic Factors of Breast Cancer

“…The presence of peritumoral vascular invasion defined an intermediate risk for patients with nodenegative breast disease. LVI is also associated with other strongest prognostic factors including tumor size, grade and regional LN involvement [46][47][48].…”

An Anaplastic Lymphoma Kinase Pathway Signature is associated with Cell De-differentiation, Neoadjuvant Response and Recurrence Risk in Breast Cancer

“…A retrospective analysis performed on 260 elderly and 294 middleaged patients with primary BC shows that negative lymph node status, small tumor size and positive ER status are favorable indicators of survival in both the elderly and the middle-aged patients [24]. In addition, another study shows that ER/PR status and HER2 gene amplification or overexpression are prognostic factors in elderly patients with BC [25]. ALK, ER/PR and HER2 share common downstream activation pathways, such as Ras/MEK/ERK and PI3K/Akt/mTOR, which ultimately lead to increased transcription, cell proliferation, growth and survival [26][27][28][29][30].…”