Abstract
Breast cancer (BC) risk increases with age; about a third of patients are diagnosed in age older than 65. Treatment of this age group remains controversial, leading to inferior outcomes with lower survival rates than younger patients. We aimed to evaluate performance status tools as well as the outcome of management of breast cancer in the geriatric population. We have conducted a retrospective database analysis looking into the management of breast cancer patients older than 65 years old presenting to our unit during the period between June 2015 and June 2019. All patients had triple assessment as well as multimodality performance status assessment with their treatment modalities, and outcomes are recorded and assessed. We have included 578 patients, 0.8% male and 99.2% female, and our patients’ mean age was 71 years. Most of our patients scored one or two on the WHO/ECOG performance status score and Clinical Frailty Score, as well as ASA-PS score. 3.2% had no treatment, 4.3% had endocrine therapy only, 0.5% had primary endocrine therapy followed by surgery, and 92.3% underwent surgery with 4.1% complication rate. Patients who underwent breast-conserving surgery had adjuvant breast radiotherapy, and 23.7% had adjuvant chest wall radiotherapy, 78.8% had adjuvant endocrine treatment, and 4.8% had adjuvant chemotherapy out of which 30.7% had adjuvant chemotherapy and Herceptin. Objective assessment tools should be used for patients older than 65 years diagnosed with primary breast cancer to be able to scarify patients’ individualised treatment options to reach the optimum outcome.
Similar content being viewed by others
Abbreviations
- BC:
-
Breast cancer
- HER2:
-
Human epidermal growth factor receptor 2 (HER2)
- ECOG PS:
-
Eastern Cooperative Oncology Group Performance Status
- WHO:
-
World Health Organization
- ASA-PS:
-
American Society of Anaesthesiologists physical status
- CFS:
-
Clinical Frailty Score
- AI:
-
Aromatase inhibitors
- pCR:
-
Pathological complete response
- NACT:
-
Neoadjuvant chemotherapy
References
Sieber CC (2007) Der ältere Patient-weristdas? Der Internist 48:1190–1194
Cancer Research UK (2017) Cancer incidence for common cancers, Cancer Research UK.Avaliable from. https://www.cancerresearchuk.org/.../cancer-statistics/incidence/common-cancers-compared. Accessed July 2020
Duggan MA, Anderson WF, Altekruse S, Penberthy L, Sherman ME (2016) The surveillance, epidemiology, and end results (SEER) program and pathology: toward strengthening the critical relationship. Am J SurgPathol 28:94–102. https://doi.org/10.1097/PAS.0000000000000749
Cancer statistics review, 1975–2013 - previous version - SEER Cancer Statistics Review. [cited. 2020 Jun]. Available from). https://seer.cancer.gov/archive/csr/1975_2013
Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6)
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 30:495. https://doi.org/10.1503/cmaj.050051
ASA physical status classification system | American Society of Anesthesiologists (ASA). Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed July 2020
Balducci L (2016) Treatment of breast cancer in women older than 80 years is a complex task. J OncolPract 12(2):133–134. https://doi.org/10.1200/JOP.2015.010405
Scher KS, Hurria A (2012) Under-representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol 30:2036–2038. https://doi.org/10.1200/JCO.2012.41.6727
Gosain R, Pollock Y, Jain D (2016) Age-related disparity: breast cancer in the elderly. Curr Oncol Rep 69
Glaser R, Marinopoulos S, Dimitrakakis C (2018) Breast cancer treatment in women over the age of 80: a tailored approach. Maturitas 110:29. https://doi.org/10.1016/j.maturitas.2018.01.014
Cardoso F, Bartlett JMS, Slaets L et al (2018) Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol Off J Eur Soc Med Oncol 29:405–417. https://doi.org/10.1093/annonc/mdx651
Fentiman IS (2016) Male breast cancer is not congruent with the female disease. Crit Rev Oncol Hematol 101:119–124. https://doi.org/10.1016/j.critrevonc.2016.02.017
Cortadellas T, Argacha P, Acosta J et al (2017) Estimation of tumor size in breast cancer comparing clinical examination, mammography, ultrasound and MRI-correlation with the pathological analysis of the surgical specimen. Gland Surg 6:330–5. https://doi.org/10.21037/gs.2017.03.09
Oluogun WA, Adedokun KA, Oyenike MA, Adeyeba OA (2019) Histological classification, grading, staging, and prognostic indexing of female breast cancer in an African population: a 10-year retrospective study. Int J Health Sci (Qassim) 3–9
Rakha EA, Aleskandarany MA, Toss MS et al (2018) Impact of breast cancer grade discordance on prediction of outcome. Histopathology 73:904–915. https://doi.org/10.1111/his
Morgan J, Wyld L, Collins KA, Reed MW (2014) Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Vol. 2014, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd.https://doi.org/10.1002/14651858.CD004272.pub2
Brain E, Caillet P, de Glas N et al (2019) HER2-targeted treatment for older patients with breast cancer: an expert position paper from the International Society of Geriatric Oncology. J Geriatr Oncol 10:1003–1013. https://doi.org/10.1016/j.jgo.2019.06.004
Hurria A, Levit LA, Dale W et al (2015) improving the evidence base for treating older adults with cancer: American Society of Clinical Oncology Statement. J Clin Oncol Off J Am Soc Clin Oncol 3826–33. https://doi.org/10.1200/JCO.2015.63.0319
Cherny N, Paluch-Shimon S, Berner-Wygoda Y (2018) Palliative care: needs of advanced breast cancer patients. Breast Cancer: Targets Therapy 10:231–243. https://doi.org/10.2147/BCTT.S160462
Cortadellas T, Córdoba O, Gascón A et al (2015) Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 41:635–40. https://doi.org/10.1007/s13670-017-0223-z
Clough KB, van la Parra RFD, Thygesen HH et al (2018) Long-term results after oncoplastic surgery for breast cancer: a 10-year follow-up. Ann Surg 268:165–71. https://doi.org/10.1097/SLA.0000000000002255
Davis C, Williams P, Redman S (2000) Early discharge following breast surgery: assessing care, support, and informational needs of women with early breast cancer in Australia. Aust N Z J Surg 70:569–572. https://doi.org/10.1046/j.1440-1622.2000.01900.x
Smith IE, Dowsett M, Ebbs SR et al (2005) Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial. J Clin Oncol Off J Am Soc Clin Oncol 23:5108–5116. https://doi.org/10.1200/JCO.2005.04.005
Pepping RMC, Portielje JEA, van de Water W, de Glas NA (2017) Primary endocrine therapy in older women with breast cancer. Curr Geriatr Rep 6:239–46. https://doi.org/10.1007/s13670-017-0223-z
Jeon YW, You SH, Lee JE et al (2019) Optimal treatment of breast cancer in women older than 75 years: a Korea Breast Cancer Registry analysis. Breast Cancer Res Treat 178:693–701
Kocik J, Pajączek M, Kryczka T (2019) Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland. BMC Cancer 19:749
Ageing and health. [cited. 2020 Jul]. Available from). https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Author information
Authors and Affiliations
Contributions
HH was responsible for the surgery and ongoing care of the patients in the hospital and provided the data as well as result analysis.SM and ME researched, drafted and conceived the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics Approval
No ethical approval was needed for this study as it was an analysis of standard practice.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Monib, S., Elkorety, M. & Habashy, H. Adequate Assessment Can Affect the Management of Breast Cancer in Geriatric Population. Indian J Surg Oncol 12, 785–791 (2021). https://doi.org/10.1007/s13193-021-01442-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-021-01442-1