TY - JOUR
T1 - Breast carcinoma in elderly women
T2 - Features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients
AU - Gennari, Roberto
AU - Curigliano, Giuseppe
AU - Rotmensz, Nicole
AU - Robertson, Chris
AU - Colleoni, Marco
AU - Zurrida, Stefano
AU - Nolè, Franco
AU - De Braud, Filippo
AU - Orlando, Laura
AU - Leonardi, Maria Cristina
AU - Galimberti, Viviana
AU - Intra, Mattia
AU - Veronesi, Paolo
AU - Renne, Giuseppe
AU - Cinieri, Saverio
AU - Audisio, Riccardo A.
AU - Luini, Alberto
AU - Orecchia, Roberto
AU - Viale, Giuseppe
AU - Goldhirsch, Aron
PY - 2004/9/15
Y1 - 2004/9/15
N2 - BACKGROUND. Aging 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. METHODS. The 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). RESULTS. EPM 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. CONCLUSIONS. In 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.
AB - BACKGROUND. Aging 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. METHODS. The 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). RESULTS. EPM 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. CONCLUSIONS. In 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.
KW - Breast carcinoma
KW - Breast-conserving surgery
KW - Elderly patients
KW - Postmenopausal
KW - Treatment
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U2 - 10.1002/cncr.20535
DO - 10.1002/cncr.20535
M3 - Article
C2 - 15316944
AN - SCOPUS:4444258770
VL - 101
SP - 1302
EP - 1310
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 6
ER -