Undertreated Breast Cancer in the Elderly

Abstract

The effect of undertreatment with adjuvant hormonal therapy, chemotherapy, or radiation was studied in elderly women with breast cancer. A prospectively maintained database was used to identify women undergoing potentially curative surgery between 1978 and 2012. The presentation, pathologic findings, treatment, and outcomes of 382 women over 70 were compared to the findings in 2065 younger patients. Subsequently, conventionally treated and undertreated elderly patients were identified and their characteristics and outcomes were compared. Both young and old patients presented most frequently with mammographic findings, but older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Cancers of older patients were significantly more favorable than cancers in younger patients: smaller, with more infiltrating lobular, fewer ductal carcinoma in situ, and more frequently estrogen receptor positive and fewer were poorly differentiated. Elderly patients had less axillary sampling, fewer mastectomies, less adjuvant radiation therapy, and more hormonal therapy. Fifty-one percent of the 382 elderly patients were undertreated by conventional criteria. Undertreated patients were more frequently in situ, better differentiated, smaller, and more often estrogen receptor positive. Forty-four percent of the undertreated patients died during followup without disease recurrence. Despite undertreatment, local and distant disease-free survival was comparable to patients who were not undertreated.

Distinct Postsurgical Management in Young and Elderly Breast Cancer Patients Results in Equal Survival Rates

“…Multiple studies indicate that elderly women receive less aggressive primary therapy, including fever axillary dissections ( esseler and Seton, 1978;August et al, 1994;Wanebo et al, 1997;Downey et al, 2007;Malik et al, 2013;Guth et al, 2013). The perceptions of potential morbidity from surgery and lack of benefit from adjuvant systemic therapy have resulted in omission of axillary surgery in elderly patients (Passage and McCarthy, 2007;Tipples and Robinson, 2009;Tang et al, 2011).…”

“…Breast cancer (BC) is one of the most common malignant diseases in women and constitutes a major, worldwide health problem, with incidence rates continuing to increase (Malik et al, 2013). Moreover, age is a dominant risk factor in the development of BC.…”

Intraoperative radiotherapy for early breast cancer and age: clinical characteristics and outcomes

“…adjuvant radiation therapy following BCS, increased use of primary endocrine therapy, and decreased use of adjuvant chemotherapy even in ''fit'' patients. [5][6][7] Accelerated partial breast irradiation (APBI), including targeted partial breast intraoperative radiation therapy (IORT) in a single session during surgery, is increasingly accepted as an alternative to whole breast EBRT with adequate local disease control and minimal morbidity. The rationale for the use of APBI including IORT is based on the observation that the majority of local recurrences occur in close proximity to the tumor bed.…”

Vers une approche multidisciplinaire optimale du traitement du cancer du sein chez les patientes plus âgées

“…Les femmes plus âgées peuvent vivre un déclin fonctionnel à la suite du diagnostic et du traitement, particulièrement celles qui présentaient des déficits cognitifs, ce qui peut mener à une perte d'autonomie (Smith et al, 2009). Il subsiste également le risque de surtraiter ou de sous-traiter ces patientes plus âgées atteintes du cancer du sein (Malik et al, 2013). Par le passé, les patientes âgées ont généralement été sous-traitées par crainte d'effets secondaires possibles du traitement (Du et al, 2003).…”