Surgery of early stage breast cancer in older women – multicenter study and review of 143 cases
AbstractMost of breast cancers are diagnosed in females over 50 years of age, however it is found that about 30% of the disease diagnosed with women above 70 years. Generally speaking, those patients is treated with a smaller range of treatment which usually offered to the younger group of patients. Despite the presence of many comorbidities, however the patient may still have a good physiological reserve, which make offering a radical surgery of the cancer very possible. Age should not be a determinant for quality of care in breast cancer. In this paper, we looked to 143 breast cancer patients with age >70 years had been operated. The oldest was 86. ASA assessment tool used Pre-operatively. Mastectomy done in 70% where 30% underwent Breast Conservation Surgery. Axillary surgery done in 94% of cases (52% Sentinel lymph node biopsy and 42% axillary clearance). The histology of the removed cancers showed invasive ductal carcinoma in 76% of cases, invasive lobular carcinoma in 11%, with DCIS in 06%. After surgery, every patient has been offered the individual suitable adjuvant treatment as chemotherapy, radiotherapy, Herceptin or hormonal manipulation. As those patients can stand the radical surgery and live with a good life quality after treatment, we advise to extend the screening program beyond the current recommended age. Also we recommend further research to understand more about the biology of the breast cancer in the older age group and disseminate geriatric assessment tool as Adult Co-morbidity Evaluation (ACE-27) to provide a proper evaluation of the patient status prior to final management decision.
Breast Cancer in the Elderly NCIN Data Briefing. UK National Cancer Intelligence Network. www.ncin.org.uk, viewd on 16 Jan 2017.
Eaker S, Dickman PW, Bergkvist L, Holmberg L. Differences in Management of Older Women Influence Breast cancer Survival: Results from a Population-Based Database in Sweden. PLoS Med. 2006 Mar;3(3):e25. www.ncbi.nlm.nih.gov.
Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open Apr 2016. esmoopen.bmj.com, viewed on 15 Jan 2017.
Bano R, Iqbal Khan A, Abbas Zaidi A, Asif Zaidi A, Chaudhry M, Khan H, Zafar W. Breast cancer treatment in a high-risk elderly patients. A challenging situation and difficult decisions. J Pak Med Assoc. 2016 Oct;66(10):1267–1271.
Herbsman H, Feldman J, Seldera J, Gardner B, Alfonso A. Survival Following Breast Cancer Surgery in the Elderly. Cancer. 1981;47:2358–2363.
Sonja E. Singletary, Shallenberger R, Vincent F. Guinee. Breast Cancer in the Elderly. Annals of Surgery. 218;5:667–671.
Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP. Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival. Journal of Clinical Oncology. 2010;28(12):2038-2045. doi:10.1200/JCO.2009.25.9796.
Kallogjeri D, Piccirillo JF, Spitznagel EL, Steyerberg EW. Comparison of Scoring Methods for ACE-27: Simpler Is Better. Journal of geriatric oncology. 2012;3(3):238-245. doi:10.1016/j.jgo.2012.01.006.
Keshtgar M, Davidson T, Pigott K, Falzon M, Jones A. Current status and advances in management of early breast cancer. Int J Surg. 2010;8(3):199-202. doi: 10.1016/j.ijsu.2010.02.004.
Abdolrasoul Talei, Majid Akrami, Maral Mokhtari and Sedigheh Tahmasebi. Surgical and Clinical Pathology of Breast Diseases. www.intechopen.com/books/histopathology.