Breast cancer in the elderly: An area for improvement

• Published in: Journal of clinical oncology Vol. 30; no. 15_suppl; p. e16565
• Main Authors: Jasra, Sakshi, Sharma, Vipra, Cohen, Alice J., Jabel, Nicole
• Format: Journal Article
• Language: English
• Published: 20.05.2012
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2012.30.15_suppl.e16565

Abstract only e16565 Background: Treatment (TX) of breast cancer (BC) in elderly (E) patients (pt) can be problematic due to the increased co-morbidities (CM), multiple medications, and cognitive dysfunction related to age. Due to this many E pt are less likely to have standardized treatment (TX). This study was undertaken to assess if pt over the age of 70 diagnosed with BC received TX based on NCCN guidelines and what CM led to selection of therapies. Methods: A retrospective review at a tertiary care medical center identified 108 pt over the age of 70 with BC from 2001-2011. Clinical data was obtained regarding race, age, stage (ST) at diagnosis, TX, CM, estrogen receptor (ER), progesterone receptor (PR), and HER2neu receptor (H2N) status. Results: Of the 108 pts, 22% were Caucasians, 66% were African-American, 3% Asian, 6% Hispanic, and 2% other. The age range was 70 to 96 years, mean of 75. Staging was as follows: 23% DCIS, 24% ST I, 28% ST II, 9% ST III, and 7% ST IV. 66% were ER positive (+), 60% PR+, and 87% H2N negative. H2N status was not available on 9% of the pts. In 92% of the pt surgical intervention (SI), either lumpectomy (L) with radiation therapy (RT), or mastectomy (M) was done (see table below). 8% of pt either refused SI or were lost to follow-up. ER/PR+ pt hormone therapy (HT) was started in 95% of pt. 3% of ER/PR+ pt refused HT. In stage II and III 60% of pt had adjuvant chemotherapy (CT), only 5% refused CT. In ST IV 30% had HT alone, 50% with CT and HT, and 25% with RT to chest wall for local recurrence. Only 23% of H2N positive pt received Herceptin. 52% of the CT used in stage II and III was cyclophosphamide, methotrexate, fluorouracil (CMF). CM in the CMF pts were as follows 90% cardiovascular disease (CAD), 53% arthritis (AR), 13% history malignancy, and 13% pulmonary disease. In the pt who refused SI, and/or CT the most common CM were 70% CAD, 50% AR, and 25% dementia. Conclusions: The majority of the E BC pt in this cohort had significant CM that made TX challenging. Some pt were not offered appropriate CT (i.e., trastuzumab) due to CM. Age impacts BC TX, but should not hinder the pt receiving optimal tx. Further studies with women over the age of 70 with BC is required to determine the most appropriate TX in this subset of pts. [Table: see text]