Advertisement

Clinical epidemiology of breast cancer in the elderly

Published:September 17, 2007DOI:https://doi.org/10.1016/j.ejca.2007.08.005

      Abstract

      Breast cancer will increasingly become a disease affecting the lives of older women, especially in more developed countries, the prevalence rising up to 7% over age 70 in the near future. A review of the population-based literature and an analysis of the data of the Eindhoven Cancer Registry and European data regarding the diagnosis, treatment and prognosis showed that the proportion with unstaged and advanced disease (stages III and IV) is higher among elderly patients compared to younger ones and that their treatment is generally less aggressive, although the proportion receiving chemotherapy is increasing since the early 1990s. Disease specific (or relative) survival of elderly breast cancer patients is generally lower and the prevalence of serious (life expectancy affecting) co-morbidity is higher (>50% in patients over age 70).
      Because of large individual variations in physical and mental conditions, limited evidence from RCTs and personal preferences prevailing in the decision-making process, treatment of older breast cancer patients seems difficult to fit into guidelines. Therefore, alternative research strategies are needed to understand and improve the care for the elderly breast cancer population, such as descriptive (registry-based) studies and a qualitative, individual-based approach.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. SignaleringscommissieKanker. Kanker in Nederland. Trends, prognoses en implicaties voor zorgvraag. Amsterdam: KWF Kankerbestrijding; 2004.

        • Bouchardy C.
        • Rapiti E.
        • Blagojevic S.
        • Vlastos A.T.
        • Vlastos G.
        Older female cancer patients: importance, causes, and consequences of undertreatment.
        J Clin Oncol. 2007; 25: 1858-1869
        • Eaker S.
        • Dickman P.W.
        • 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; 3: e25
        • Doyle J.J.
        • Neugut A.I.
        • Jacobson J.S.
        • et al.
        Radiation therapy, cardiac risk factors, and cardiac toxicity in early-stage breast cancer patients.
        Int J Radiat Oncol Biol Phys. 2007; 68: 82-93
        • Bouchardy C.
        • Rapiti E.
        • Fioretta G.
        • et al.
        Undertreatment strongly decreases prognosis of breast cancer in elderly women.
        J Clin Oncol. 2003; 21: 3580-3587
        • Sant M.
        • Allemani C.
        • Berrino F.
        • et al.
        Breast carcinoma survival in Europe and the United States.
        Cancer. 2004; 100: 715-722
        • Adams J.
        • Audisio R.A.
        • White M.
        • Forman D.
        Age-related variations in progression of cancer at diagnosis and completeness of cancer registry data.
        Surg Oncol. 2004; 13: 175-179
        • Randolph W.M.
        • Goodwin J.S.
        • Mahnken J.D.
        • Freeman J.L.
        Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis.
        Ann Intern Med. 2002; 137: 783-790
        • Lavelle K.
        • Todd C.
        • Moran A.
        • Howell A.
        • Bundred N.
        • Campbell M.
        Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or =65 years.
        Br J Cancer. 2007; 96: 1197-1203
        • Doyle J.J.
        • Neugut A.I.
        • Jacobson J.S.
        • Grann V.R.
        • Hershman D.L.
        Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study.
        J Clin Oncol. 2005; 23: 8597-8605
        • Elkin E.B.
        • Hurria A.
        • Mitra N.
        • Schrag D.
        • Panageas K.S.
        Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort.
        J Clin Oncol. 2006; 24: 2757-2764
        • Giordano S.H.
        • Duan Z.
        • Kuo Y.F.
        • Hortobagyi G.N.
        • Goodwin J.S.
        Use and outcomes of adjuvant chemotherapy in older women with breast cancer.
        J Clin Oncol. 2006; 24: 2750-2756
        • Louwman W.J.
        • Janssen-Heijnen M.L.
        • Houterman S.
        • et al.
        Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study.
        Eur J Cancer. 2005; 41: 779-785
        • Mustacchi G.
        • Cazzaniga M.
        • Pronzato P.
        • De Matteis A.
        • Di Costanzo F.
        • Floriani I.
        Breast cancer in elderly women: a different reality? Results from the NORA study.
        Ann Oncol. 2007; 18: 991-996
        • Du X.
        • Goodwin J.S.
        Increase of chemotherapy use in older women with breast carcinoma from 1991 to 1996.
        Cancer. 2001; 92: 730-737
        • Smith B.D.
        • Haffty B.G.
        • Hurria A.
        • Galusha D.H.
        • Gross C.P.
        Postmastectomy radiation and survival in older women with breast cancer.
        J Clin Oncol. 2006; 24: 4901-4907
        • Punglia R.S.
        • Weeks J.C.
        • Neville B.A.
        • Earle C.C.
        Radiation therapy after mastectomy between 1991 and 1999 in elderly women: response to clinical trial information.
        J Clin Oncol. 2006; 24: 3474-3482
        • Janssen-Heijnen M.L.
        • Houterman S.
        • Lemmens V.E.
        • Louwman M.W.
        • Maas H.A.
        • Coebergh J.W.
        Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach.
        Crit Rev Oncol Hematol. 2005; 55: 231-240
        • Roazzi P.
        • Capocaccia R.
        • Santaquilani M.
        • Carrani E.
        Electronic availability of EUROCARE-3 data: a tool for further analysis.
        Ann Oncol. 2003; 14: v150-v155
        • Sant M.
        • Aareleid T.
        • Berrino F.
        • et al.
        EUROCARE-3: survival of cancer patients diagnosed 1990-94–results and commentary.
        Ann Oncol. 2003; 14: v61-v118
        • Houterman S.
        • Janssen-Heijnen M.L.
        • Verheij C.D.
        • et al.
        Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients.
        Br J Cancer. 2004; 90: 2332-2337
        • Coebergh J.W.
        • Crommelin M.A.
        • Kluck H.M.
        • van Beek M.
        • van der Horst F.
        • Verhagen-Teulings M.T.
        Breast cancer in southeast North Brabant and in North Limburg; trends in incidence and earlier diagnosis in an unscreened female population, 1975–1986.
        Ned Tijdschr Geneeskd. 1990; 134: 760-765
      2. [Annual report 2005] in Dutch. ’s Hertogenbosch: Stichting Bevolkingsonderzoek Borstkanker Zuid; 2006.

      3. Duijm LE, Groenewoud JH, Roumen RM, de Koning HJ, Plaisier ML, Fracheboud J. A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer. Breast Cancer Res Treat 2007, .

        • Robinson D.
        • Sankila R.
        • Hakulinen T.
        • Moller H.
        Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates.
        Eur J Cancer. 2007; 43: 909-913
        • Pollock A.M.
        • Vickers N.
        Why are a quarter of all cancer deaths in south-east England registered by death certificate only? Factors related to death certificate only registrations in the Thames Cancer Registry between 1987 and 1989.
        Br J Cancer. 1995; 71: 637-641
        • Molino A.
        • Giovannini M.
        • Auriemma A.
        • et al.
        Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer.
        Crit Rev Oncol Hematol. 2006; 59: 226-233
        • Mandelblatt J.
        Treating breast cancer: the age old dilemma of old age.
        J Clin Oncol. 2006; 24: 4369-4370
        • Siesling S.
        • van de Poll-Franse L.V.
        • Jobsen J.J.
        • Repelaer van Driel O.J.
        • Voogd A.C.
        Explanatory factors for variation in the use of breast conserving surgery and radiotherapy in the Netherlands, 1990–2001.
        Breast. 2007; https://doi.org/10.1016/j.breast.2007.05.004
        • Vulto A.J.
        • Lemmens V.E.
        • Louwman M.W.
        • et al.
        The influence of age and comorbidity on receiving radiotherapy as part of primary treatment for cancer in South Netherlands, 1995 to 2002.
        Cancer. 2006; 106: 2734-2742
        • Hebert-Croteau N.
        • Brisson J.
        • Latreille J.
        • Blanchette C.
        • Deschenes L.
        Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women.
        Cancer. 1999; 85: 1104-1113
        • Giordano S.H.
        • Hortobagyi G.N.
        • Kau S.W.
        • Theriault R.L.
        • Bondy M.L.
        Breast cancer treatment guidelines in older women.
        J Clin Oncol. 2005; 23: 783-791
        • Gorin S.S.
        • Heck J.E.
        • Cheng B.
        • Smith S.J.
        Delays in breast cancer diagnosis and treatment by racial/ethnic group.
        Arch Intern Med. 2006; 166: 2244-2252
        • Siu L.L.
        Clinical trials in the elderly–a concept comes of age.
        N Engl J Med. 2007; 356: 1575-1576
        • Bijker N.
        • Peterse J.L.
        • Fentiman I.S.
        • et al.
        Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS.
        Br J Cancer. 2002; 87: 615-620
        • Kimmick G.G.
        • Peterson B.L.
        • Kornblith A.B.
        • et al.
        Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001.
        J Clin Oncol. 2005; 23: 2201-2207
        • Hillner B.E.
        • Mandelblatt J.
        Caring for older women with breast cancer: can observational research fill the clinical trial gap?.
        J Natl Cancer Inst. 2006; 98: 660-661
        • Extermann M.
        • Aapro M.
        • Bernabei R.
        • et al.
        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. 2005; 55: 241-252
        • Jansen S.J.
        • Otten W.
        • Stiggelbout A.M.
        Review of determinants of patients’ preferences for adjuvant therapy in cancer.
        J Clin Oncol. 2004; 22: 3181-3190
        • Duric V.
        • Stockler M.
        Patients’ preferences for adjuvant chemotherapy in early breast cancer: a review of what makes it worthwhile.
        Lancet Oncol. 2001; 2: 691-697
        • Mandelblatt J.
        • Kreling B.
        • Figeuriedo M.
        • Feng S.
        What is the impact of shared decision making on treatment and outcomes for older women with breast cancer?.
        J Clin Oncol. 2006; 24: 4908-4913
        • Aziz D.
        • Gardner S.
        • Pritchard K.
        • Paszat L.
        • Holloway C.M.
        Selective application of axillary node dissection in elderly women with early breast cancer.
        Ann Surg Oncol. 2007; 14: 652-659
        • Smith B.D.
        • Gross C.P.
        • Smith G.L.
        • Galusha D.H.
        • Bekelman J.E.
        • Haffty B.G.
        Effectiveness of radiation therapy for older women with early breast cancer.
        J Natl Cancer Inst. 2006; 98: 681-690
        • Du X.L.
        • Osborne C.
        • Goodwin J.S.
        Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer.
        J Clin Oncol. 2002; 20: 4636-4642