J Breast Cancer.  2007 Sep;10(3):199-205. 10.4048/jbc.2007.10.3.199.

The Clinical Characteristics and Outcome of Breast Cancer Patients Older than 70 Years

• Lee JS
• Hong SJ
• Kim HJ
• Son BH
• Kim SB
• Ahn JH
• Ahn SD
• Ahn SH

• KMID: 2175036
• DOI: http://doi.org/10.4048/jbc.2007.10.3.199

Abstract

PURPOSE: There is no concensus on the type of therapy useful for elderly cancer patients. Since 2000, Korea has become an elderly society. This study aims to assess clinical characteristics of elderly breast cancer women, and to evaluate determinants and effects of treatment choice for breast cancer prognosis among elderly patients.
METHODS
We reviewed the clinical reports of 123 breast cancer patients aged > or =70 yr recorded at the Asan Medical Center Breast Cancer Registry between 1992 and 2002. Patient and tumor chariteristics, comorbidity, surgical method, adjuvant therapy and cause of death were taken into consideration. Survival analysis was determined according to the treatment method.
RESULTS
The median time to diagnosis was 33.6 months. Only 9 patients (5.1%) were diagnosed in the screening program. A modified radical mastectomy was performed for 74 patients (60.1%), Breast conserving surgery was performed for 26 patients (24.7%), and there was no further curative therapy for 12 patients (9.7%). 32 patients (38.1%) had axillary lymph node metastasis. The median follow-up duration was 43.1 months; the overall survival rate was 71.8%, and the disease free survival rate was 65.4%. Breast cancer related mortality was 62.8%.
CONCLUSION
Delayed diagnosis and infrequent screening were frequent among elderly patients. Cancer related morbidity was less than general breast cancer patients. Treatment needs to be adapted to the general health status of the patient and comorbid conditions, but has to offer the best chance of cure, regardless of age.

Keyword

Elderly women; Breast cancer; Adjuvant therapy

MeSH Terms

Aged
Breast Neoplasms*
Breast*
Cause of Death
Chungcheongnam-do
Comorbidity
Delayed Diagnosis
Diagnosis
Disease-Free Survival
Female
Follow-Up Studies
Humans
Korea
Lymph Nodes
Mass Screening
Mastectomy, Modified Radical
Mastectomy, Segmental
Mortality
Neoplasm Metastasis
Prognosis
Survival Rate

Figure

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  Fig 1 Overall survival according to stage. Log-rank test p<0.001.

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  Fig 2 Overall survival according to axillary lymph node metastasis. Log-rank test p=0.05.

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  Fig 3 Overall survival according to hormone receptor status. Log-rank test p=0.003.

Reference

1. Holmes CE, Muss HB. Diagnosis and treatment of breast cancer in the elderly. CA Cancer J Clin. 2003. 53:227–244.

2. Crivellari D, Bonetti M, Castiglione-Gertsch M, Gelber RD, Rudenstam CM, Thurlimann B, et al. Burdens and benefits of adjuvant Cyclophosphamide, Methotrexate, and Fluorouracil and Tamoxifen for elderly patients with breast cancer: the international breast cancer study group trial VII. J Clin Oncol. 2000. 18:1412–1422.

3. Parkin DM, Muir CS. Cancer Incidence in Five continents. Comparability and quality of data. IARC Sci Publ. 1992. 120:45–173.

4. De Haes H, Curran D, Aaronson NK, Fentiman IS. Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomized clinical trial. Eur J Cancer. 2003. 39:945–951.

5. Newschaffer CJ, Penberthy L, Desch CE, Retchin SM, Whittemore M. The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med. 1996. 156:85–90.

6. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer charateristics, 2006. CA Cancer J Clin. 2006. 56:106–130.

7. Son BH, Kwack BS, Kim JK, Kim HJ, Hong SJ, Lee JS, et al. Changing patterns in the clinical charateristics of Korean Patients with breast cancer during the last 15 years. Arch Surg. 2006. 141:155–160.

8. Gong G, Kim MJ, Shim YH, Kang GH, Ahn SH, Ro JY, et al. Nationwide Korean breast cancer data of 2004 using breast cancer registration program. Korean Breast Cacner Soc. 2006. 9:151–161.

9. Goldhirsch A, Glick JH, Gelber RD, Senn HJ. Meeting highlights: International Consensus Panel on the treatment of primary breast cancer. J Natl Cancer Inst. 1998. 90:1601–1608.

10. Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography: a meta analysis. JAMA. 1995. 273:149–154.

11. Thomas LR, Fox SA, Leake BG, Roetzheim RG. The effects of health beliefs on screening mammography utilization among a diverse sample of older women. Women Health. 1996. 24:77–94.

12. Turnbull AD, Gundy E, Howland WS, Beattle EJ Jr. Surgical mortality among the elderly. An analysis of 4050 operations (1970-1974). Clin Bull. 1978. 8:139–142.

13. Yancik R, Ries LG, Yates JW. Breast cancer in aging women: a population-based study of contrasts in stage, surgery, and survival. Cancer. 1989. 63:976–981.

14. Solin LJ, Schultz DJ, Fowble BL. Ten-year results of the treatment of early-stage breast carcinoma in elderly women using breast conserving surgery and definitive breast irradiation. Int J Radiat Oncol Biol Phys. 1995. 33:45–51.

15. Merchant TE, McCormick B, Yahalom J, Borgen P. The influence of old age on breast cancer treatment decisions and outcome. Int J Radiat Oncol Biol Phys. 1996. 34:565–570.

16. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underpresentation of patients 65years of age or older in cancer-treatment trials. N Engl J Med. 1999. 341:2061–2067.

17. Silliman RA, Troyan SL, Guadagnoli E, Kaplan SH, Greenfield S. The impact of age, marital status, and physician-patients interactions on the care of older women with breast carcinoma. Cancer. 1997. 80:1326–1334.

18. Mandelblatt JS, Handley J, Kerner JF, Schulman KA, Gold K, Dun-more-Griffith J, et al. Patterns of breast carcinoma treatment in older women: patients preference and clinical and physical influences. Cancer. 2000. 89:561–573.

19. Busch E, Kemeny M, Fremgen A, Osteen RT, Winchester DP, Clive RE. Patterns of breast cancer care in the elderly. Cancer. 1996. 78:101–111.

20. Gajdos C, Tartter PI, Bleiweiss IJ, Lopchinsky RA, Bernstein JL. The consequence of undertreating breast cancer in the elderly. J Am Coll Surg. 2001. 192:698–707.

21. Diab SG, Elledge RM, Clark GM. Tumor charateristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000. 92:550–556.

22. Pappo I, Karni T, Sandbank J, Dinur I, Sella A, Stahl-Kent V, et al. Breast cancer in the elderly: histological, hormonal and surgical charateristics. Breast. 2007. 16:60–67.

23. Honma N, Sakamoto G, Akiyama F, Esaki Y, Sawabe M, Arai T, et al. Breast carcinoma in women over the age of 85: distinct histological pattern and androgen, estrogen,and progesterone receptor status. Histopathology. 2003. 42:120–127.

24. Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet. 1998. 352:930–942.

25. Satariano WA. Aging, comorbidity, and breast cancer survival: an epidermiologic view. Adv Exp Med Biol. 1993. 330:1–11.