Breast carcinoma in elderly women

Cancer - Tập 101 Số 6 - Trang 1302-1310 - 2004
Roberto Gennari1, Giuseppe Curigliano2, Nicole Rotmensz3, Chris Robertson3, Marco Colleoni2, Stefano Zurrida1, Franco Nolé2, Filippo de Braud2, Laura Orlando2, Maria Cristina Leonardi4, Viviana Galimberti1, Mattia Intra1, Paolo Veronesi1, Giuseppe Renne5, Saverio Cinieri1, Riccardo A. Audisio6, Alberto Luini1, Roberto Orecchia4,7, Giuseppe Viale5,7, Aron Goldhirsch2
1Department of Surgery, European Institute of Oncology, Milan - Italy
2Department of Medicine, Division of Medical Oncology, European Institute of Oncology, Milan, Italy
3Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
4Department of Medicine, Division of Radiotherapy, European Institute of Oncology, Milan, Italy
5Division of Pathology, European Institute of Oncology, Milan, Italy
6University of Liverpool, Whiston Hospital, Prescot, United Kingdom
7University of Milano School of Medicine, Milan, Italy

Tóm tắt

AbstractBACKGROUNDAging remains one of the single greatest risk factors for the development of new breast carcinoma. The aim of the study was to evaluate the relation between biologic features at first diagnosis of breast carcinoma and treatment choice for postmenopausal women ≥ 50 years to optimize treatment in the elderly.METHODSThe sample included 2999 consecutive postmenopausal patients referred for surgery at the European Institute of Oncology (Milan, Italy) from April 1997 to February 2002. The patients were grouped according to age: young postmenopausal (YPM; 50–64 years, n = 2052), older postmenopausal (OPM; 65–74, n = 801), and elderly postmenopausal (EPM; ≥ 75, n = 146).RESULTSEPM patients referred to surgery had larger tumors compared with YPM patients (pT4: 6.7% vs. 2.4%) as well as greater lymph node involvement (lymph node positive: 62.5% vs. 51.3%). EPM patients showed a higher degree of estrogen and progesterone receptor expression (P < 0.01), less peritumoral vascular invasion (P < 0.01), and less HER‐2/neu expression (P < 0.01) than YPM patients. Comorbidities were more often recorded for elderly patients (72% EPM vs. 45% YPM; P < 0.001), did not influence surgical choices, and were similar across groups (breast conservation: 73.9%, 76.9%, and 72.9%, respectively). No systemic therapy (either chemotherapy or endocrine therapy) was recommended for 19.1% of the EPM compared with 5.4% and 4.7% of the two other groups.CONCLUSIONSIn spite of larger tumor size at presentation, older patients had tumors with more favorable biologic characteristics, when compared with younger postmenopausal patients. Reluctance to prescribe systemic treatments was due to the complexity of evaluation for these patients. Taking into account the data from the current study and given the climate of uncertainty regarding optimal treatment, the authors decided to individualize care on the basis of biologic characteristics, comorbidity, social support, functional status, and patient preferences. Trials of tailored adjuvant therapy should be a health care priority. Cancer 2004. © 2004 American Cancer Society.

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Cancer

Tập 101 Số 6

1302-1310

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