Document Type : Original Article
Authors
- Majid Akrami 1
- Sedigheh Tahmasebi 1
- Mahdi shariat 2
- Vahid Moradi Ranjbar 3
- Zahra Keumarsi 4
- Masoumeh Ghoddusi Johari 5
1 Associate professor, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Radiooncotherpy Specialist, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Medical Doctor, Shiraz University of Medical Sciences, Shiraz, Iran
4 Master in Biostatistics, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
5 Assistant professor, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Introduction: Breast cancer is one of the most common invasive cancers being the leading cause of mortality among women all around the world. Although the increasing trend of the geriatric population with cancer is indicative of good advances in cancer early detection and treatment, since most studies have been conducted on younger age group, it can be said that the principles of treatment in geriatric patients remains unclear due to the vagueness of prognostic factors in this age group.
Methods: This study was conducted using the data obtained from Shiraz Breast Cancer Registry, the largest breast cancer registry in Iran. The study population included women aged 70 years and over who had breast cancer. Prognostic factors, treatment modalities, and patients’ survival rate were reviewed and investigated.
Result: 427 patients were included in this study. The mean age of patients was 75 years old +/- 5.2yrs. Invasive ductal carcinoma (73.3%), Grade 2 tumor (56.9 %), and size 2-5cm (50.6%) were the most common histopathological type, respectively. 81.9% of the patients were positive for estrogen receptor. 47.5% of the patients underwent quadrantectomy. 50.8% received adjuvant chemotherapy and 41.1% received adjuvant radiotherapy. The overall survival rate for women for more than 5 years (60 months) was 68% and disease-free survival rate for more than 5 years was 51%.
Conclusion: According to ISGO recommendation to improve breast cancer survival in the elderly, in addition to the need for more critical reappraisal in breast cancer management in this age group by clinicians, the involvement of geriatricians is needed to appraise the patients’ general condition in this age group in order to meet the treatment guidelines requirements.
Keywords
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394-424.
- Yazdani-Charati R, Hajian-Tilaki K, Sharbatdaran M. Comparison of pathologic characteristics of breast cancer in younger and older women. Caspian journal of internal medicine. 2019;10(1):42.
- Rottenberg Y, Naeim A, Uziely B, Peretz T, Jacobs JM. Breast cancer among older women: The influence of age and cancer stage on survival. Archives of gerontology and geriatrics.
2018;76:60-4. - Tesarova P. Breast cancer in the elderly—Should it be treated differently? Reports of Practical Oncology & Radiotherapy. 2013;18(1):26-33.
- Álvarez-Bañuelos M, Rosado-Alcocer L, Morales-Romero J, Román Álvarez L, Guzmán-García R, Carvajal-Moreno M. Prognostic factors associated with survival in women with breast cancer from Veracruz, Mexico. J Cancer Sci Ther. 2016;8(4):092-6.
- Fusco D, Allocca E, Villani ER, Franza L, Laudisio A, Colloca G. An update in breast cancer management for elderly patients. Transl Cancer Res. 2018;7:S319-28.
- Karuturi M, VanderWalde N, Muss H. Approach and management of breast cancer in the elderly. Clinics in geriatric medicine. 2016;32(1):133-53.
- Ojala K, Meretoja TJ, Mattson J, Leidenius MH. Surgical treatment and prognosis of breast cancer in elderly–A population-based study. European Journal of Surgical Oncology. 2019;45(6):956-62.
- Yao L, Zhang Y-X, Wang L-H, Zhang X-Y, Yan W, Pang D. Breast cancer in
65-year-old or older patients: clinicopathological characteristics and prognosis. Oncology Research and Treatment. 2012;35(6):358-61. - Vazquez FDL, Silva TB, Vieira RAdC, Da Costa AM, Scapulatempo C, Fregnani JHTG, et al. Retrospective analysis of breast cancer prognosis among young and older women in a Brazilian cohort of 738 patients, 1985-2002. Oncology letters. 2016;12(6):4911-24.
- Cappellani A, Di Vita M, Zanghì A, Cavallaro A, Piccolo G, Majorana M, et al. Prognostic factors in elderly patients with breast cancer. BMC surgery. 2013;13(2):1-12.
- Smith IE, Fribbens C. Management of breast cancer in older and frail patients. The Breast. 2015;24:S159-S62.
- Kiderlen M, de Glas NA, Bastiaannet E, van de Water W, de Craen AJ, Guicherit OR, et al. Impact of comorbidity on outcome of older breast cancer patients: a FOCUS cohort study. Breast cancer research and treatment. 2014;145(1):185-92.
- Schrauder MG, Fasching PA, Häberle L, Lux MP, Rauh C, Hein A, et al. Diabetes and prognosis in a breast
cancer cohort. Journal of cancer research and clinical oncology. 2011;137(6):975-83. - Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. New England Journal of Medicine. 1993;328(22):1587-91.
- Yazdi SMM, Najafi M, Muhammadnejad A, Omranipour R, Shirkhoda M. Management of Elderly Breast Cancer Patients Referred to the Cancer Institute of Iran during 2000-2014: Call For a National Guideline. Basic & Clinical Cancer Research. 2018;10(3):22-9.
- Kaplan HG, Malmgren JA, Atwood MK. Triple‐negative breast cancer in the elderly: Prognosis and treatment. The breast journal. 2017;23(6):630-637.
- Quaglia A, Tavilla A, Shack L, Brenner H, Janssen-Heijnen M, Allemani C, et al. The cancer survival gap between elderly and middle-aged patients in Europe is widening. European Journal of Cancer. 2009;45(6):1006-16.
- Bastiaannet E, Portielje JE, van de Velde CJ, de Craen AJ, van der Velde S, Kuppen PJ, et al. Lack of survival
gain for elderly women with breast cancer. The oncologist. 2011;16(4):415. - O’Connor T, Shinde A, Doan MC, Katheria MV, Hurria A. Managing breast cancer in the older patient. Clinical advances in hematology & oncology: H&O. 2013;11(6):341.
- Schuil H, Derks M, Liefers G-J, Portielje J, van de Velde C, Syed B, et al. Treatment strategies and survival outcomes in older women with breast cancer: a comparative study between the focus cohort and Nottingham cohort. Journal of geriatric oncology. 2018;9(6):635-41.
- Gennari R, Rotmensz N, Perego E, Dos Santos G, Veronesi U. Sentinel node biopsy in elderly breast cancer patients. Surgical Oncology. 2004;13(4):193-6.
- Durbecq V, Ameye L, Veys I, Paesmans M, Desmedt C, Sirtaine N, et al. A significant proportion of elderly patients develop hormone-dependant “luminal-B” tumours associated with aggressive characteristics. Critical reviews in oncology/hematology. 2008;67(1):80-92.
- Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, et al. Comprehensive geriatric assessment
adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. Journal of clinical oncology. 2002;20(2):494-502. - Clough-Gorr KM, Stuck AE, Thwin SS, Silliman RA. Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. Journal of clinical oncology. 2010;28(3):380.
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