Definition
Breast cancer is a type of cancer that develops from breast tissue (National Cancer Institute 2012). Breast cancer can be separated roughly into three main groups or phenotypes: (i) estrogen receptors (ER) and/or progesterone receptors (PgR) positive (ER+/PgR+) (~75%), or so-called luminal; (ii) human epidermal growth factor receptor 2 overexpressed (HER2+) (~15%), whether ER/PgR+ or ER/PgR−; and (iii) ER−, PgR−, and HER2− (~10%), or so-called triple-negative or basal-like.
Overview
Breast cancer is the most frequent cancer among women in developed countries (Henley et al. 2020). Increasing age is the main risk factor for breast cancer, of which about 40% are diagnosed after 65 years (Biganzoli et al. 2012). However, older women are underrepresented in breast cancer clinical trials (Hurria et al. 2014), making standard management often poorly evidence-based and established wrongly on extrapolations of results obtained in younger ones.
In older women aged 80 years and older,...
References
Alliance Cancer in the Older Adult Committee, Adjei A, Buckner JC, Cathcart-Rake E, Chen H, Cohen HJ, Dao D et al (2020) Arti Hurria, M.D.: a tribute to her shining legacy in the Alliance for Clinical Trials in Oncology. J Geriatr Oncol 11(2):179–183. https://doi.org/10.1016/j.jgo.2019.05.011
American Cancer Society (2019) Cancer facts & figures 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
Baselga J, Cortés J, Kim S-B, Im S-A, Hegg R, Im Y-H, Roman L et al (2012) Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 366(2):109–119
Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M et al (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13(4):e148–e160
Bouchardy C, Rapiti E, Blagojevic S, Vlastos A-T, Vlastos G (2007) Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol 25(14):1858–1869. https://doi.org/10.1200/JCO.2006.10.4208
Brain E, Caillet P, de Glas N, Biganzoli L, Cheng K, Dal Lago L, Wildiers H (2019) HER2-targeted treatment for older patients with breast cancer: an expert position paper from the International Society of Geriatric Oncology. J Geriatr Oncol 10(6):1003–1013. https://doi.org/10.1016/j.jgo.2019.06.004
Brollo J, Curigliano G, Disalvatore D, Marrone BF, Criscitiello C, Bagnardi V, Kneubil MC et al (2013) Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: a systematic review of randomized controlled trials. Cancer Treat Rev 39(1):44–50. https://doi.org/10.1016/j.ctrv.2012.03.009
Chavez-MacGregor M, Niu J, Zhang N, Elting LS, Smith BD, Banchs J, Hortobagyi GN, Giordano SH (2015) Cardiac monitoring during adjuvant trastuzumab-based chemotherapy among older patients with breast cancer. J Clin Oncol 33(19):2176–2183. https://doi.org/10.1200/JCO.2014.58.9465
Dang C, Iyengar N, Datko F, D’Andrea G, Theodoulou M, Dickler M, Goldfarb S et al (2015) Phase II study of paclitaxel given once per week along with trastuzumab and pertuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol 33(5):442–447. https://doi.org/10.1200/JCO.2014.57.1745
Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, Abraham M et al (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 381(9869):805–816. https://doi.org/10.1016/S0140-6736(12)61963-1
Deng Y, Ma G, Li W, Wang T, Zhao Y, Wu Q (2018) CDK4/6 inhibitors in combination with hormone therapy for HR+/HER2− advanced breast cancer: a systematic review and meta-analysis of randomized controlled trials. Clin Breast Cancer 18(5):e943–e953. https://doi.org/10.1016/j.clbc.2018.04.017
Donker M, Litière S, Werutsky G, Julien J-P, Fentiman IS, Agresti R, Rouanet P et al (2013) Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol. https://doi.org/10.1200/JCO.2013.49.5077
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 12;378(9804):1707–16. https://doi.org/10.1016/S0140-6736(11)61629-2
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J, Gray R, Pan HC, Clarke M et al (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379(9814):432–444. https://doi.org/10.1016/S0140-6736(11)61625-5
Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz J-P, Lichtman S, Mor V et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55(3):241–252. https://doi.org/10.1016/j.critrevonc.2005.06.003
Freedman OC, Fletcher GG, Gandhi S, Mates M, Dent SF, Trudeau ME, Eisen A (2015) Adjuvant endocrine therapy for early breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline. Curr Oncol 22(Suppl 1):S95–S113. https://doi.org/10.3747/co.22.2326
Henley SJ, Ward EM, Scott S, Ma J, Anderson RN, Firth AU, Thomas CC et al (2020) Annual report to the nation on the status of cancer, Part I: national cancer statistics. Cancer. https://doi.org/10.1002/cncr.32802
Hind D, Wyld L, Reed MW (2007) Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Cancer 96(7):1025–1029. https://doi.org/10.1038/sj.bjc.6603600
Howie LJ, Singh H, Bloomquist E, Wedam S, Amiri-Kordestani L, Tang S, Sridhara R et al (2019) Outcomes of older women with hormone receptor–positive, human epidermal growth factor receptor–negative metastatic breast cancer treated with a CDK4/6 inhibitor and an aromatase inhibitor: an FDA pooled analysis. J Clin Oncol 37(36):3475–3483. https://doi.org/10.1200/JCO.18.02217
Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, Muss HB et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31(19):2382–2387. https://doi.org/10.1200/JCO.2012.45.2615
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465. https://doi.org/10.1200/JCO.2011.34.7625
Hurria A, Dale W, Mooney M, Rowland JH, Ballman KV, Cohen HJ, Muss HB et al (2014) Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 32(24): 2587–2594. https://doi.org/10.1200/JCO.2013.55.0418
Hurria A, Magnuson A, Gross CP, Tew WP, Klepin HD, Wildes TM, Muss HB et al (2018) Development and validation of a chemotherapy toxicity (chemo tox) risk score for older patients (Pts) with breast cancer (BC) receiving adjuvant/neoadjuvant treatment (adjuvant Tx): a R01 and BCRF funded prospective multicenter study. Abstract, SABCS, General Session 6. https://www.abstracts2view.com/sabcs/view.php?nu=SABCS18L_1273&terms
Johnston S, Pippen J, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL et al (2009) Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol 27(33): 5538–5546. https://doi.org/10.1200/JCO.2009.23.3734
Jones S, Holmes FA, O’Shaughnessy J, Blum JL, Vukelja SJ, McIntyre KJ, Pippen JE et al (2009) Docetaxel with cyclophosphamide is associated with an overall survival benefit compared with doxorubicin and cyclophosphamide: 7-year follow-up of US oncology research trial 9735. J Clin Oncol 27(8): 1177–1183. https://doi.org/10.1200/JCO.2008.18.4028
Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, Tjulandin S et al (2009) Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol 27(33):5529–5537. https://doi.org/10.1200/JCO.2008.20.6847
Krop IE, Kim S-B, González-Martín A, LoRusso PM, Ferrero J-M, Smitt M, Yu R, Leung ACF, Wildiers H (2014) Trastuzumab emtansine versus treatment of physician’s choice for pretreated HER2-positive advanced breast cancer (TH3RESA): a randomised, open-label, phase 3 trial. Lancet Oncol 15(7): 689–699. https://doi.org/10.1016/S1470-2045(14)70178-0
Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 16(3):266–273
Lavelle K, Downing A, Thomas J, Lawrence G, Forman D, Oliver SE (2012) Are lower rates of surgery amongst older women with breast cancer in the UK explained by co-morbidity? Br J Cancer 107(7):1175–1180. https://doi.org/10.1038/bjc.2012.192
Meattini I, Poortmans PMP, Marrazzo L, Desideri I, Brain E, Hamaker M, Lambertini M et al (2020) Exclusive endocrine therapy or partial breast irradiation for women aged ≥70 years with luminal A-like early stage breast cancer (NCT04134598 – EUROPA): proof of concept of a randomized controlled trial comparing health related quality of life by patient reported outcome measures. J Geriatr Oncol
Muss HB, Polley M-YC, Berry DA, Liu H, Cirrincione CT, Theodoulou M, Mauer AM et al (2019) Randomized trial of standard adjuvant chemotherapy regimens versus capecitabine in older women with early breast cancer: 10-year update of the CALGB 49907 trial. J Clin Oncol 37(26):2338–2348. https://doi.org/10.1200/JCO.19.00647
National Cancer Institute (2012) What you need to know about breast cancer. NIH publication no. 12-1556. National Cancer Institute. https://web.archive.org/web/20140705110022/http://www.cancer.gov/cancertopics/wyntk/breast/WYNTK_breast.pdf. Accessed 13 May 2020
Newschaffer CJ, Penberthy L, Desch CE, Retchin SM, Whittemore M (1996) The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med 156(1):85–90
Perrone F, Nuzzo F, Di Rella F, Gravina A, Iodice G, Labonia V, Landi G et al (2015) Weekly docetaxel versus CMF as adjuvant chemotherapy for older women with early breast cancer: final results of the randomized phase III ELDA trial. Ann Oncol 26(4):675–682. https://doi.org/10.1093/annonc/mdu564
Robertson JFR, Bondarenko IM, Trishkina E, Dvorkin M, Panasci L, Manikhas A, Shparyk Y et al (2016) Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial. Lancet 388(10063):2997–3005. https://doi.org/10.1016/S0140-6736(16)32389-3
Schmid P, Adams S, Rugo HS, Schneeweiss A, Barrios CH, Iwata H, Diéras V et al (2018) Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer. N Engl J Med 379(22): 2108–2121. https://doi.org/10.1056/NEJMoa1809615
Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP (2010) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28(12):2038–2045. https://doi.org/10.1200/JCO.2009.25.9796
Schonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP (2011) Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol 29(12):1570–1577. https://doi.org/10.1200/JCO.2010.33.0472
Shachar SS, Hurria A, Muss HB (2016) Breast cancer in women older than 80 years. J Oncol Pract 12(2): 123–132. https://doi.org/10.1200/JOP.2015.010207
Spring LM, Gupta A, Reynolds KL, Gadd MA, Ellisen LW, Isakoff SJ, Moy B, Bardia A (2016) Neoadjuvant endocrine therapy for estrogen receptor-positive breast cancer: a systematic review and meta-analysis. JAMA Oncol 2(11):1477–1486. https://doi.org/10.1001/jamaoncol.2016.1897
Straver ME, Meijnen P, van Tienhoven G, van de Velde CJH, Mansel RE, Bogaerts J, Demonty G et al (2010) Role of axillary clearance after a tumor-positive sentinel node in the administration of adjuvant therapy in early breast cancer. J Clin Oncol 28(5):731–737. https://doi.org/10.1200/JCO.2008.21.7554
Tolaney SM, Barry WT, Dang CT, Yardley DA, Moy B, Kelly Marcom P, Albain KS et al (2015) Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. N Engl J Med 372(2):134–141. https://doi.org/10.1056/NEJMoa1406281
von Minckwitz G, Huang C-S, Mano MS, Loibl S, Mamounas EP, Untch M, Wolmark N et al (2019) Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med 380(7): 617–628. https://doi.org/10.1056/NEJMoa1814017
Whelan TJ, Pignol J-P, Levine MN, Julian JA, MacKenzie R, Parpia S, Shelley W et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362(6):513–520. https://doi.org/10.1056/NEJMoa0906260
Wildiers H, Tryfonidis K, Lago LD, Vuylsteke P, Curigliano G, Waters S, Brouwers B et al (2018) Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer (EORTC 75111-10114): an open-label, randomised, phase 2 trial from the Elderly Task Force/Breast Cancer Group. Lancet Oncol 19(3):323–336. https://doi.org/10.1016/S1470-2045(18)30083-4
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Geiss, R., Gattas-Vernaglia, I., Brain, E. (2020). Tumors: Breast. In: Gu, D., Dupre, M. (eds) Encyclopedia of Gerontology and Population Aging. Springer, Cham. https://doi.org/10.1007/978-3-319-69892-2_774-1
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DOI: https://doi.org/10.1007/978-3-319-69892-2_774-1
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