Tumor characteristics and therapy of elderly patients with breast cancer

Grumpelt, A.-M.; Ignatov, Atanas; Tchaikovski, Svetlana; Burger, Elke; Costa, Serban Dan; Eggemann, Holm

doi:10.1007/s00432-015-2111-2

Cited by 33 publications

(21 citation statements)

References 22 publications

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“…Radiotherapy after primary surgery was performed less frequently in the oldest age group in a study by Weggelaar et al [37] agreeing with our results and with previous studies reporting less loco-regional surgery and frequent omission of radiotherapy in elderly patients [34, 36, 39–41]. …”

Section: Discussionsupporting

confidence: 93%

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Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology

Inwald¹,

Ortmann²,

Koller

et al. 2017

Breast Cancer Res Treat

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PurposeThe 70-year threshold determines whether patients are eligible or not for the breast cancer screening program in Germany. It is not known whether this age threshold also influences the choice of adjuvant treatment and ultimate outcome.Methods3463 patients were analyzed from the clinical cancer registry Regensburg (Germany) with primary, non-metastatic invasive breast cancer diagnosed between 2000 and 2012. The distribution of tumor biological subtypes was evaluated in breast cancer patients both in those eligible for screening (ESG, 50–69 years) and those not eligible for screening (NESG, ≥70 years). Local and systemic therapies in different subtypes as well as overall survival (OS) were analyzed.Results2171 patients (62.7%) pertained to the ESG and 1292 patients (37.3%) referred to the NESG. The distribution of the common subtypes Luminal A, Luminal B, HER2-like, and Basal-like was comparable in both groups. Treatment varied considerably with less systemic therapies in all subtypes in patients in the NESG. Regarding local therapies, patients in the NESG also received less surgery and less radiotherapy. As to Luminal A patients, best OS was seen in patients receiving endocrine therapy (ET) (7-year OS of 95.6%) and CHT plus ET (7-year OS of 93.1%) in the ESG. In the NESG, best OS was seen in patients receiving CHT plus ET (7-year OS of 95.2%), whereas patients receiving only ET had a 7-year OS of 73.9%.ConclusionsDespite similar tumor biology, elderly patients are undertreated regarding both systemic and local therapies compared to younger patients, leading to reduced OS.

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Section: Discussionsupporting

confidence: 93%

“…A subgroup analysis from the herceptin adjuvant study (HERA) showed an effect of trastuzumab independent of age [33]. In line with the findings of Grumpelt et al, we observed that the use of trastuzumab was insufficient both in the ESG and the NESG [34]. …”

Section: Discussionsupporting

confidence: 84%

Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology

Inwald¹,

Ortmann²,

Koller

et al. 2017

Breast Cancer Res Treat

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“…The causes of lower rates of improvement in the survival of elderly and widowed patients with localized disease and of Caucasians with ER-and PRdisease compared with those observed in younger patients and patients with ER+ and PR+ disease, respectively, may be multivariate. Standard guideline therapy, including surgery, are not administered to elderly patients at the same rate as to younger women (47)(48)(49)(50). Co-morbidities in older women often result in faster deterioration following chemotherapy than in younger women and are significant factors in therapeutic decisions and survival (51).…”

Section: Discussionmentioning

confidence: 99%

Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer

Wieder¹,

Shafiq²,

Adam³

2020

J. Cancer

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Background: African American women have not benefited equally from recently improved breast cancer survival. We investigated if this was true for all subsets. Methods: We identified 395,170 patients with breast adenocarcinoma from the SEER database from 1990 to 2011 with designated race, age, stage, grade, ER and PR status, marital status and laterality, as control. We grouped patients into two time periods, 1990-2000 and 2001-2011, three age categories, under 40, 40-69 and > 70 years and two stage categories, I-III and IV. We used the Kaplan-Meier and logrank tests to compare survival curves. We stratified data by patient-and tumor-associated variables to determine co-variation among confounding factors using the Pearson Chi-square test and Cox proportional hazards regression to determine hazard ratios (HR) to compare survival. Results: Stage I-III patients of both races > 70 years old, African American widowed patients and Caucasians with ER-and PR-tumors had worse improvements in survival in 2001-2011 than younger, married or hormone receptor positive patients, respectively. In contrast, African Americans with ER-(Cox HR 0.70 [95% CI 0.65-0.76]) and PR-(Cox HR 0.67 [95% CI 0.62-0.72]) had greater improvement in survival in 2001-2011 than Caucasians with ER-(Cox HR 0.81 [95% CI 0.78-0.84]) and PR-disease (Cox HR 0.75 [95% CI 0.73-0.78]). This was not associated with changes in distribution of tumor or patient attributes. Conclusions: African American women with stage I-III ER-and PR-breast cancer had greater improvement in survival than Caucasians in 2001-2011. This is the first report of an improvement in racial disparities in survival from breast cancer in a subset of patients.

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“…Indeed, patients in the older group may not have been referred for breast cancer screening at all given the recommended age limit for screening of 70-75 years. The comparable nodal status could suggest a different or more benign pattern of tumor progression in elderly patients [7,[19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Early Breast Cancer in the Elderly: Characteristics, Therapy, and Long-Term Outcome

Gal

Ishai²,

Sulkes³

et al. 2017

Oncology

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Objective: The number of older adults diagnosed with breast cancer is increasing. However, data on breast cancer characteristics, treatment, and survival in elderly women are sparse. Methods: The database of a tertiary cancer center was searched for all women aged ≥65 years who were diagnosed with early breast cancer in 2004-2007. Patients were divided into 2 age groups: 65-75 years and >75 years. Data on tumor, treatment, and outcome parameters were compared. Results: The cohort included 390 patients. The older group underwent more mastectomies but less axillary surgery or adjuvant systemic therapy. Median overall survival (OS) was 9.5 years in the older group and not reached in the younger group; the 8-year disease-free survival rates were 85 and 88%, respectively (p = 0.27). Both age and tumor subtype had an effect on OS and recurrence rates (p < 0.001 for OS; p = 0.16 for recurrence). The worst outcome was noted in women aged >75 years with triple-negative (TN) disease. Conclusion: The treatment approach was different between both age groups, despite similar tumor characteristics. TN subtype presented as the most aggressive disease in both age groups. Physicians should be alert to these findings and select treatment on a case-by-case basis.

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Tumor characteristics and therapy of elderly patients with breast cancer

Abstract: The older group's reduced disease-free survival could be explained by the tumor characteristics and differences in the adjuvant treatment. Remarkably, elderly women are more likely to be overtreated surgically while being undertreated in terms of adjuvant therapy.

Cited by 33 publications

References 22 publications

Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology

Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology

Greater Survival Improvement in African American vs. Caucasian Women with Hormone Negative Breast Cancer

Early Breast Cancer in the Elderly: Characteristics, Therapy, and Long-Term Outcome

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