Tumor characteristics and the research progress in diagnosis and treatment of elderly patients with breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Siye , CHEN Maoshan ,  YANG Guanglun

Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R.China;

Corresponding author：

YANG Guanglun, Email: guanglunyang@163.com

Keywords：

breast cancer; elderly; treatment

DOI：

10.7507/1007-9424.201607090

Video：

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Objective To summarize the tumor characteristics and the research progress in diagnosis and treatment of elderly patients with breast cancer. Methods To combine the literature review and clinical guidelines, to introduce tumor characteristics, the advance of diagnosis and therapy and expert consensus in elderly breast cancer. Results Compared to the patients in other age group, the elderly patients with breast cancer have special physiological and psychoical characteristics, meanwhile aged patients frequently together with basic disease, the strategy of clinical diagnosis and treatment and prognosis are very different from young and middle-aged patients. Conclusion For the elderly patients with breast cancer, we should formulate the corresponding treatment plan on the premise of the comprehensive evaluation of patients’ life expectancy, with the disease, the degree of benefit, treatment tolerance and other factors.

Citation： LIU Siye, CHEN Maoshan, YANG Guanglun. Tumor characteristics and the research progress in diagnosis and treatment of elderly patients with breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 518-524. doi: 10.7507/1007-9424.201607090 Copy

1.	DeSantis CE, Fedewa SA, Goding Sauer A,et al. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin, 2016, 66(1): 31-42.
2.	Fan L, Strasser-Weippl K, Li JJ,et al. Breast cancer in China. Lancet Oncol, 2014, 15(7): e279-e289.
3.	Ma CD, Zhou Q, Nie XQ,et al. Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns. Crit Rev Oncol Hematol, 2009, 71(3) : 258-265.
4.	Schonberg MA, Marcantonio ER, Li D,et al. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol, 2010, 28(12): 2038-2045.
5.	Griffith KA, Sabel MS, Newman LA,et al. The elderly breast cancer patient: Association of age, tumor size, and grade with sentinel lymph node status. J Clin Oncol, 2012, 30(27_Suppl): 15.
6.	Grumpelt AM, Ignatov A, Tchaikovski SN,et al. Tumor characteristics and therapy of elderly patients with breast cancer. J Cancer Res Clinl Oncol, 2016, 142(5): 1109-1116.
7.	de Munck L, Schaapveld M, Siesling S,et al. Implementation of trastuzumab in conjunction with adjuvant chemotherapy in the treatment of non-metastatic breast cancer in the Netherlands. Breast Cancer Res Treat, 2011, 129(1): 229-233.
8.	Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst, 2000, 92(7): 550-556.
9.	韩颖. 老年乳腺癌的特点及其化学治疗策略. 癌症进展, 2014, 12(3): 233-237.
10.	赵卫红, 徐兵河, 李青, 等. 70岁以上老年女性乳腺癌患者的特点和预后分析. 中华肿瘤杂志, 2006, 28(5): 385-388.
11.	Vetter M, Huang DJ, Bosshard G,et al. Breast cancer in women 80 years of age and older: a comprehensive analysis of an underre-ported entity. Acta Oncol, 2013, 52(1): 57-65.
12.	Ali AM, Greenberg D, Wishart GC,et al. Patient and tumor characteristics,management, and age-specific survival in women with breast cancer in the East of England. Br J Cancer, 2011, 104(4): 564-570.
13.	卢晓红. 青、老年乳腺癌淋巴结转移规律的分析. 中国肿瘤临床与康复, 2002, 9(6): 85-86.
14.	Biganzoli L, Wildiers H, Oakman C,et al. 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, 2012, 13(4): e148-e160.
15.	Martelli G, Miceli R, Daidone MG,et al. Axillary dissectionversus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol, 2011, 18(1): 125-133.
16.	Giuliano AE, Hunt KK, Ballman KV,et al. Axillary dissectionvs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA, 2011, 305(6): 569-575.
17.	Chen J, Zhang C, Li F,et al. A meta-analysis of clinical trials assessing the effect of radiofrequency ablation for breast cancer. Onco Targets Ther, 2016, 9: 1759-1766.
18.	Palussière J, Henriques C, Mauriac L,et al. Radiofrequency ablation as a substitute for surgery in elderly patients with nonresected breast cancer: pilot study with long-term outcomes. Radiology, 2012, 264(2): 597-605.
19.	Susini T, Nori J, Olivieri S,et al. Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients. Gynecol Oncol, 2006, 104(2): 304-310.
20.	Coombes RC, Kilburn LS, Snowdon CF,et al. Survival and safety of exemestaneversus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet, 2007, 369(9561): 559-570.
21.	Kaufmann M, Jonat W, Hilfrich J,et al. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. J Clin Oncol, 2007, 25(19): 2664-2670.
22.	Morgan J, Wyld L, Collins KA,et al. Surgeryversus primary endocrine therapy for operableprimary breast cancer in elderly women (70 years plus). The Cochrane Library, Published Online: 16 MAY 2014,.
23.	National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Breast cancer, Version 2. , 2016-05-16.
24.	Hughes KS, Schnaper LA, Bellon JR,et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. J Clin Oncol, 2013, 31(19): 2382-2387.
25.	Giordano SH, Duan Z, Kuo YF,et al. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol, 2006, 24(18): 2750-2756.
26.	Muss HB, Berry DA, Cirrincione CT,et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med, 2009, 360(20): 2055-2065.
27.	Pinder MC, Duan Z, Goodwin JS,et al. Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. J Clin Oncol, 2007, 25(25): 3808-3815.
28.	Du XL, Xia R, Liu CC,et al. Cardiac toxicity associated with anthracycline-containing chemotherapy in older women with breast cancer. Cancer, 2009, 115(22): 5296-5308.
29.	Hershman DL, McBride RB, Eisenberger A,et al. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol, 2008, 26(19): 3159-3165.
30.	Miles D, Baselga J, Amadori D,et al. Treatment of older patients with HER2-positive metastatic breast cancer with pertuzumab, trastuzumab, and docetaxel: subgroup analyses from a randomized, double-blind, placebo-controlled phase Ⅲ trial (CLEOPATRA). Breast Cancer Res Treat, 2013, 142(1): 89-99.
31.	Chavez-MacGregor M, Zhang N, Buchholz TA,et al. Tras-tuzumab-related cardiotoxicity among older patients with breast cancer. J Clin Oncol, 2013, 31(33): 4222-4228.
32.	Pritchard KI, Burris HA 3rd, Ito Y,et al. Safety and efficacy of everolimus with exemestanevs. exemestane alone in elderly patients with HER2-negative, hormone receptor-positive breast cancer in BOLERO-2. Clin Breast Cancer, 2013, 13(6): 421-432.
33.	Ragaz J, Jackson SM, Le N,et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med, 1997, 337(14): 956-962.
34.	Overgaard M, Hansen PS, Overgaard J,et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med, 1997, 337(14): 949-955.
35.	Harris JR, Halpin-Murphy P, McNeese M,et al. Consensus Statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys, 1999, 44(5): 989-990.
36.	Recht A, Edge SB, Solin LJ,et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol, 2001, 19(5): 1539-1569.
37.	National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst Monogr, 2001, 30: 5-15.
38.	Smith BD, Haffty BG, Hurria A,et al. Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol, 2006, 24(30): 4901-4907.
39.	Truong PT, Lee J, Kader HA,et al. Locoregional recurrence risks in elderly cancer patients treated with mastectomy without adjuvant radiotherapy. Eur J Cancer, 2005, 41(9): 1267-1277.
40.	Hughes KS, Schnaper LA, Bellon JR,et al . 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, 2013, 31(19): 2382-2387.
41.	Fyles AW, McCready DR, Manchul LA,et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med, 2004, 351(10): 963-970.
42.	Smith BD, Haffy BG, Buchholz TA,et al. Effevtiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst, 2006, 98(18): 1302-1310.
43.	Truong PT, Bernstein V, Lesperance M,et al. Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg, 2006, 191(6): 749-755.
44.	Martelli G, Boracchi P, Guzzetti E,et al. Omission of radiotherapy in elderly patients with early breast cancer: 15-Year results of a prospective non-randomised trial. Eur J Cancer, 2015, 51(11): 1358-1364.
45.	Bastiaannet E, Liefers GJ, de Craen AJ,et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127 805 unselected patients. Breast Cancer Res Treat, 2010, 124(3): 801-807.
46.	Patnaik JL, Byers T, Diguiseppi C,et al. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst, 2011, 103(14): 1101-1111.
47.	Schonberg MA, Marcantonio ER, Ngo L,et al. Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol, 2011, 29(12): 1570-1577.

1. DeSantis CE, Fedewa SA, Goding Sauer A,et al. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin, 2016, 66(1): 31-42.
2. Fan L, Strasser-Weippl K, Li JJ,et al. Breast cancer in China. Lancet Oncol, 2014, 15(7): e279-e289.
3. Ma CD, Zhou Q, Nie XQ,et al. Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns. Crit Rev Oncol Hematol, 2009, 71(3) : 258-265.
4. Schonberg MA, Marcantonio ER, Li D,et al. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol, 2010, 28(12): 2038-2045.
5. Griffith KA, Sabel MS, Newman LA,et al. The elderly breast cancer patient: Association of age, tumor size, and grade with sentinel lymph node status. J Clin Oncol, 2012, 30(27_Suppl): 15.
6. Grumpelt AM, Ignatov A, Tchaikovski SN,et al. Tumor characteristics and therapy of elderly patients with breast cancer. J Cancer Res Clinl Oncol, 2016, 142(5): 1109-1116.
7. de Munck L, Schaapveld M, Siesling S,et al. Implementation of trastuzumab in conjunction with adjuvant chemotherapy in the treatment of non-metastatic breast cancer in the Netherlands. Breast Cancer Res Treat, 2011, 129(1): 229-233.
8. Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst, 2000, 92(7): 550-556.
9. 韩颖. 老年乳腺癌的特点及其化学治疗策略. 癌症进展, 2014, 12(3): 233-237.
10. 赵卫红, 徐兵河, 李青, 等. 70岁以上老年女性乳腺癌患者的特点和预后分析. 中华肿瘤杂志, 2006, 28(5): 385-388.
11. Vetter M, Huang DJ, Bosshard G,et al. Breast cancer in women 80 years of age and older: a comprehensive analysis of an underre-ported entity. Acta Oncol, 2013, 52(1): 57-65.
12. Ali AM, Greenberg D, Wishart GC,et al. Patient and tumor characteristics,management, and age-specific survival in women with breast cancer in the East of England. Br J Cancer, 2011, 104(4): 564-570.
13. 卢晓红. 青、老年乳腺癌淋巴结转移规律的分析. 中国肿瘤临床与康复, 2002, 9(6): 85-86.
14. Biganzoli L, Wildiers H, Oakman C,et al. 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, 2012, 13(4): e148-e160.
15. Martelli G, Miceli R, Daidone MG,et al. Axillary dissectionversus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol, 2011, 18(1): 125-133.
16. Giuliano AE, Hunt KK, Ballman KV,et al. Axillary dissectionvs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA, 2011, 305(6): 569-575.
17. Chen J, Zhang C, Li F,et al. A meta-analysis of clinical trials assessing the effect of radiofrequency ablation for breast cancer. Onco Targets Ther, 2016, 9: 1759-1766.
18. Palussière J, Henriques C, Mauriac L,et al. Radiofrequency ablation as a substitute for surgery in elderly patients with nonresected breast cancer: pilot study with long-term outcomes. Radiology, 2012, 264(2): 597-605.
19. Susini T, Nori J, Olivieri S,et al. Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients. Gynecol Oncol, 2006, 104(2): 304-310.
20. Coombes RC, Kilburn LS, Snowdon CF,et al. Survival and safety of exemestaneversus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet, 2007, 369(9561): 559-570.
21. Kaufmann M, Jonat W, Hilfrich J,et al. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. J Clin Oncol, 2007, 25(19): 2664-2670.
22. Morgan J, Wyld L, Collins KA,et al. Surgeryversus primary endocrine therapy for operableprimary breast cancer in elderly women (70 years plus). The Cochrane Library, Published Online: 16 MAY 2014,.
23. National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Breast cancer, Version 2. , 2016-05-16.
24. Hughes KS, Schnaper LA, Bellon JR,et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. J Clin Oncol, 2013, 31(19): 2382-2387.
25. Giordano SH, Duan Z, Kuo YF,et al. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol, 2006, 24(18): 2750-2756.
26. Muss HB, Berry DA, Cirrincione CT,et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med, 2009, 360(20): 2055-2065.
27. Pinder MC, Duan Z, Goodwin JS,et al. Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. J Clin Oncol, 2007, 25(25): 3808-3815.
28. Du XL, Xia R, Liu CC,et al. Cardiac toxicity associated with anthracycline-containing chemotherapy in older women with breast cancer. Cancer, 2009, 115(22): 5296-5308.
29. Hershman DL, McBride RB, Eisenberger A,et al. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol, 2008, 26(19): 3159-3165.
30. Miles D, Baselga J, Amadori D,et al. Treatment of older patients with HER2-positive metastatic breast cancer with pertuzumab, trastuzumab, and docetaxel: subgroup analyses from a randomized, double-blind, placebo-controlled phase Ⅲ trial (CLEOPATRA). Breast Cancer Res Treat, 2013, 142(1): 89-99.
31. Chavez-MacGregor M, Zhang N, Buchholz TA,et al. Tras-tuzumab-related cardiotoxicity among older patients with breast cancer. J Clin Oncol, 2013, 31(33): 4222-4228.
32. Pritchard KI, Burris HA 3rd, Ito Y,et al. Safety and efficacy of everolimus with exemestanevs. exemestane alone in elderly patients with HER2-negative, hormone receptor-positive breast cancer in BOLERO-2. Clin Breast Cancer, 2013, 13(6): 421-432.
33. Ragaz J, Jackson SM, Le N,et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med, 1997, 337(14): 956-962.
34. Overgaard M, Hansen PS, Overgaard J,et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med, 1997, 337(14): 949-955.
35. Harris JR, Halpin-Murphy P, McNeese M,et al. Consensus Statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys, 1999, 44(5): 989-990.
36. Recht A, Edge SB, Solin LJ,et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol, 2001, 19(5): 1539-1569.
37. National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst Monogr, 2001, 30: 5-15.
38. Smith BD, Haffty BG, Hurria A,et al. Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol, 2006, 24(30): 4901-4907.
39. Truong PT, Lee J, Kader HA,et al. Locoregional recurrence risks in elderly cancer patients treated with mastectomy without adjuvant radiotherapy. Eur J Cancer, 2005, 41(9): 1267-1277.
40. Hughes KS, Schnaper LA, Bellon JR,et al . 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, 2013, 31(19): 2382-2387.
41. Fyles AW, McCready DR, Manchul LA,et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med, 2004, 351(10): 963-970.
42. Smith BD, Haffy BG, Buchholz TA,et al. Effevtiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst, 2006, 98(18): 1302-1310.
43. Truong PT, Bernstein V, Lesperance M,et al. Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg, 2006, 191(6): 749-755.
44. Martelli G, Boracchi P, Guzzetti E,et al. Omission of radiotherapy in elderly patients with early breast cancer: 15-Year results of a prospective non-randomised trial. Eur J Cancer, 2015, 51(11): 1358-1364.
45. Bastiaannet E, Liefers GJ, de Craen AJ,et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127 805 unselected patients. Breast Cancer Res Treat, 2010, 124(3): 801-807.
46. Patnaik JL, Byers T, Diguiseppi C,et al. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst, 2011, 103(14): 1101-1111.
47. Schonberg MA, Marcantonio ER, Ngo L,et al. Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol, 2011, 29(12): 1570-1577.

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Tumor characteristics and the research progress in diagnosis and treatment of elderly patients with breast cancer

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