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; greater than or equal to75, 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.

Breast carcinoma in elderly women : features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients / R. Gennari, G. Curigliano, N. Rotmensz, C. Robertson, M. Colleoni, S. Zurrida, F. Nole, F. de Braud, L. Orlando, M. Leonardi, V. Galimberti, M. Intra, P. Veronesi, G. Renne, S. Cinieri, R. Audisio, A. Luini, R. Orecchia, G. Viale, A. Goldhirsch, G. Viale. - In: CANCER. - ISSN 0008-543X. - 101:6(2004), pp. 1302-1310. ((Intervento presentato al 39. convegno Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) tenutosi a Chicago nel 2003.

Breast carcinoma in elderly women : features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients

Curigliano G;Zurrida S;de Braud F;Orlando L;Galimberti V;Veronesi P;Renne G;Orecchia R;Viale G;
2004

Abstract

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; greater than or equal to75, 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.
breast carcinoma; elderly patients; postmenopausal; treatment; breastconserving surgery
Settore MED/06 - Oncologia Medica
CANCER
ASCO
Article (author)
File in questo prodotto:
File Dimensione Formato  
cncr.20535.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 86.7 kB
Formato Adobe PDF
86.7 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/656084
Citazioni
  • ???jsp.display-item.citation.pmc??? 39
  • Scopus 172
  • ???jsp.display-item.citation.isi??? 142
social impact