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Syed BM, Parks RM, Cheung KL. Management of operable primary breast cancer in older women. WOMENS HEALTH 2014; 10:405-22. [PMID: 25259901 DOI: 10.2217/whe.14.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A considerable number of breast cancer diagnoses are made in older women. Differing physiological needs of older patients and biology of tumors compared with younger patients may alter treatment options between surgery and nonsurgical primary approaches. Adjuvant therapies may benefit these patients; however, concerns about toxicity and physical demands of treatment may affect patient choice regarding treatment. Furthermore, quality of life may be more important to the older individual than curative treatment alone. Growing evidence is emerging for employing Comprehensive Geriatric Assessment to determine other factors that may contribute to treatment decision-making in the older population. The way geriatric oncology is delivered varies, bringing the importance of the multidisciplinary team to the forefront of care delivery in this age group. Future research in this area should include combined consideration of tumor biology and geriatric needs.
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Affiliation(s)
- Binafsha M Syed
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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2
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Li JJ, Yu KDA, DI GH, Shao ZM. Clinicopathological features and treatment sensitivity of elderly Chinese breast cancer patients. Oncol Lett 2010; 1:1037-1043. [PMID: 22870109 DOI: 10.3892/ol.2010.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 07/22/2010] [Indexed: 11/06/2022] Open
Abstract
This study aimed to determine the clinicopathological features and treatment sensitivity of elderly breast cancer patients in China. The clinical data of 594 elderly breast cancer patients of 70 or more years of age were collected and compared to those of 657 patients of less than 70 years of age to analyze whether breast cancer in the elderly is different and whether the difference affected outcome. The median age was 75.2 years in the elderly patients and 49.8 years in the young patients. Age of menarche, parous status and body mass index were similar in the two groups. A higher frequency of steroid receptor-positive rate, a lower expression of HER-2 and p53, less axillary node-positive rate and earlier tumor stage were found in patients of 70 years or older. The 5-year relapse-free survival (RFS) and overall survival (OS) was 77 and 82% in the elderly and 86 and 93% in the young patients, respectively. Patients with estrogen receptor (ER)-positive or lymph node (LN)-negative cancers showed a more favorable outcome in the elderly patients. RFS and OS were increased in elderly patients who underwent endocrine therapy or omitted chemotherapy. Breast cancer in the elderly had more favorable tumor features, using estrogen receptor and lymph node status as prognostic factors. It was therefore concluded that adjuvant endocrine therapy may benefit elderly patients, while chemotherapy may not.
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Affiliation(s)
- Jun-Jie Li
- Department of Breast Surgery, Cancer Hospital/Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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3
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Chakrabarti J, Kenny FS, Syed BM, Robertson JFR, Blamey RW, Cheung KL. A randomised trial of mastectomy only versus tamoxifen for treating elderly patients with operable primary breast cancer-final results at 20-year follow-up. Crit Rev Oncol Hematol 2010; 78:260-4. [PMID: 20447833 DOI: 10.1016/j.critrevonc.2010.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 03/19/2010] [Accepted: 04/09/2010] [Indexed: 11/16/2022] Open
Abstract
A recent Cochrane review of trials involving elderly women with operable primary breast cancer showed no significant difference in overall survival between surgery (±adjuvant tamoxifen) and primary endocrine therapy using tamoxifen. We report the final results of a randomised pilot trial comparing primary tamoxifen and wedge mastectomy as initial treatment in this population. One hundred and thirty-one women >70 years with early operable primary breast cancer (<5 cm), unselected for oestrogen receptor (ER), entered the trial in 1982-1987. Sixty-eight patients were allocated to tamoxifen only and 67 to wedge mastectomy only, as primary treatment. At 20 years of follow-up, the median time to local failure was significantly shorter in the tamoxifen arm though approximately one-fifth of patients in this group did not develop local failure requiring mastectomy. There was no difference in regional recurrence, distant metastases or overall survival between the mastectomy and tamoxifen arms. In this small study, primary endocrine therapy achieved local control in 30% of those surviving at 5 years and 20% at 10 years, unselected for ER. The primary therapy used did not significantly affect regional recurrence, incidence of distant metastases or overall survival. Primary endocrine therapy should certainly be considered in those patients with ER positive tumours and who are unfit (based on life expectancy) for or refuse surgery.
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Affiliation(s)
- J Chakrabarti
- Division of Breast Surgery, University of Nottingham, UK
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4
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Cserni G, Bianchi S, Vezzosi V, Arisio R, Bori R, Peterse JL, Sapino A, Castellano I, Drijkoningen M, Kulka J, Eusebi V, Foschini MP, Bellocq JP, Marin C, Thorstenson S, Amendoeira I, Reiner-Concin A, Decker T, Lacerda M, Figueiredo P, Fejes G. Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multi-institutional study. Pathol Oncol Res 2007; 13:5-14. [PMID: 17387383 DOI: 10.1007/bf02893435] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 01/29/2007] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node (SLN) biopsy has become the preferred method for the nodal staging of early breast cancer, but controversy exists regarding its universal use and consequences in small tumors. 2929 cases of breast carcinomas not larger than 15 mm and staged with SLN biopsy with or without axillary dissection were collected from the authors' institutions. The pathology of the SLNs included multilevel hematoxylin and eosin (HE) staining. Cytokeratin immunohistochemistry (IHC) was commonly used for cases negative with HE staining. Variables influencing SLN involvement and non-SLN involvement were studied with logistic regression. Factors that influenced SLN involvement included tumor size, multifocality, grade and age. Small tumors up to 4 mm (including in situ and microinvasive carcinomas) seem to have SLN involvement in less than 10%. Non-SLN metastases were associated with tumor grade, the ratio of involved SLNs and SLN involvement type. Isolated tumor cells were not likely to be associated with further nodal load, whereas micrometastases had some subsets with low risk of non-SLN involvement and subsets with higher proportion of further nodal spread. In situ and microinvasive carcinomas have a very low risk of SLN involvement, therefore, these tumors might not need SLN biopsy for staging, and this may be the approach used for very small invasive carcinomas. If an SLN is involved, isolated tumor cells are rarely if ever associated with non-SLN metastases, and subsets of micrometastatic SLN involvement may be approached similarly. With macrometastases the risk of non-SLN involvement increases, and further axillary treatment should be generally indicated.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, H-6000, Hungary.
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5
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Grube BJ. Barriers to diagnosis and treatment of breast cancer in the older woman. J Am Coll Surg 2006; 202:495-508. [PMID: 16500255 DOI: 10.1016/j.jamcollsurg.2005.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 10/28/2005] [Accepted: 11/08/2005] [Indexed: 12/21/2022]
Affiliation(s)
- Baiba J Grube
- Department of Surgery, Surgical Breast Health Program, The University of Texas Medical Branch, Galveston, TX 77555-0737, USA.
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6
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Fentiman IS. New approaches to operable breast cancer in older women. Eur J Cancer Care (Engl) 2004; 13:473-82. [PMID: 15606715 DOI: 10.1111/j.1365-2354.2004.00549.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ian S Fentiman
- Guy's King's & St Thomas' School of Medicine, Guy's Hospital, London, UK.
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7
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Djordjevic N, Karanikolic A, Pesic M. Breast cancer in elderly women. Arch Gerontol Geriatr 2004; 39:291-9. [PMID: 15381348 DOI: 10.1016/j.archger.2004.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 04/29/2004] [Accepted: 05/06/2004] [Indexed: 11/18/2022]
Abstract
Although the number of elderly patients with breast cancer is increasing, knowledge about possible differences in the biology and clinical outcomes of breast cancer according to age is limited. Retrospectively were followed: diagnosis, surgical treatment, stage of disease, histology, and survival of breast cancer treated women at the Surgical and Oncological Clinic in Nis between 1985 and 1990. Patients were divided in two groups: study (=65 years) and control (<65 years). The study involved 2196 women (862 study group; 1334 control group). Ductal carcinoma was the most frequently observed histological type (70.3% versus 61.92%). The majority of our patients presented with early-stage disease (69.02% versus 60.20%). Estrogen receptor positive tumors occurred in 67.88% of elderly patients versus 28.42% of young cases, and negative axillary lymph nodes were observed in 45.78 and 34.40% of patients in the elderly and young group, respectively. Modified radical mastectomy was selected by a large proportion of patients in both groups. Adjuvant radiation and chemotherapy were more frequently performed in the younger group (P < 1 x 10(-8)). There is no significant difference in disease-specific survival by age. In our population the presentation, surgical treatment, and survival from breast cancer is similar in older and younger women.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Carcinoma, Medullary/diagnosis
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/surgery
- Case-Control Studies
- Female
- Humans
- Incidence
- Lymphatic Metastasis
- Mammography
- Middle Aged
- Neoplasm Staging
- Physical Examination
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Nebojsa Djordjevic
- Surgical Clinic, Clinical Centre of Nis, School of Medicine, University of Nis, Vardarska 23, Nis 18000, Serbia and Montenegro, Yugoslavia
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8
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Cserni G, Gregori D, Merletti F, Sapino A, Mano MP, Ponti A, Sandrucci S, Baltás B, Bussolati G. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 2004; 91:1245-52. [PMID: 15376203 DOI: 10.1002/bjs.4725] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The need for further axillary treatment in patients with breast cancer with low-volume sentinel node (SN) involvement (micrometastases or smaller) is controversial. METHODS Twenty-five studies reporting on non-SN involvement associated with low-volume SN involvement were identified using Medline and a meta-analysis was performed. RESULTS The weighted mean estimate for the incidence of non-SN metastases after low-volume SN involvement is around 20 per cent, whereas this incidence is around 9 per cent if the SN involvement is detected by immunohistochemistry (IHC) alone. Subset analyses suggest that studies with axillary dissection after any type of SN involvement result in somewhat higher estimates than studies allowing omission of axillary clearance, as do studies with more detailed histological evaluation of the SN compared with those with a less intensive histological protocol. Higher-quality papers yield lower pooled estimates than lower-quality papers. CONCLUSION The risk of non-SN metastasis with a low-volume metastasis in the SN is around 10-15 per cent, depending on the method of detection of SN involvement. This should be taken into account when assessing the risk of omission of axillary dissection after a positive SN biopsy yielding micrometastatic or immunohistochemically positive SNs.
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Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary.
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9
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Abstract
BACKGROUND Breast cancer is a major source of morbidity and mortality in elderly women. Despite this, many trials on which clinical practice is based have under-represented the elderly. Consequently there is little evidence to guide best practice in this age group. METHODS A search of the major literature databases was performed using the search terms 'breast cancer' and 'elderly'. Articles relevant to the treatment of breast cancer in the elderly were selected. RESULTS The elderly receive less aggressive treatment for breast cancer compared with younger patients. Primary endocrine therapy is sometimes substituted for operation, and axillary surgery, adjuvant chemotherapy and adjuvant radiotherapy are commonly omitted. Evidence for and against such treatment strategies is inadequate, making it difficult to determine what constitutes best practice. CONCLUSION There is a need for research to be targeted at the older age group of patients with breast cancer to enable the development of specific treatment guidelines.
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Affiliation(s)
- L Wyld
- Academic Surgical Oncology Unit, University of Sheffield, K Floor, Royal Hallamshire Hospital, Glossop Road, UK
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10
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Blamey RW. Estimation of prognosis of the individual with primary breast cancer and its applications. Scand J Surg 2003; 91:273-8. [PMID: 12449471 DOI: 10.1177/145749690209100311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Strickland AH, Beechey-Newman N, Steer CB, Harper PG. Sentinel node biopsy: an in depth appraisal. Crit Rev Oncol Hematol 2002; 44:45-70. [PMID: 12398999 DOI: 10.1016/s1040-8428(02)00018-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sentinel node biopsy (SNB) in primary breast cancer has been taken-up widely to avoid the morbidity attributable to axillary node clearance (ANC). Currently many issues surrounding SNB are undecided. This review summarises why some form of axillary surgery is required and presents data on all aspects of SNB including methodology, clinical results and problems that may delay the introduction of SNB as best practice for all patients with primary breast cancer. There is no long or medium term data relating to the consequences of replacing ANC with SNB, but the mechanisms and probable magnitude of both beneficial and detrimental effects are estimated. A low level of false negative results are inherent to the technique but it is demonstrated that SNB is likely to have an only marginal (0.6%) effect on survival that would be undetectable by clinical trials. Patient sub-groups particularly likely to benefit from SNB are identified.
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Affiliation(s)
- Andrew H Strickland
- Department of Medical Oncology, Monash Medical Centre, East Bentleigh, Vic. 3165, Australia
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12
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Ernst MF, Voogd AC, Balder W, Klinkenbijl JHG, Roukema JA. Early and late morbidity associated with axillary levels I-III dissection in breast cancer. J Surg Oncol 2002; 79:151-5; discussion 156. [PMID: 11870664 DOI: 10.1002/jso.10061] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Axillary dissection may cause substantial morbidity in breast cancer patients. The purpose of this study was to investigate the value of a registration method of morbidity of the arm and shoulder, which is frequently used by surgeons and which includes the measurement of range of movement, strength, and pain. METHODS We surveyed 148 patients who had received an axillary dissection as part of breast cancer surgery. Of these patients, 77 had undergone axillary dissection 6-12 months ago and 71 patients more than 5 years ago. In all patients, an objective measurement of shoulder movement and a subjective measurement of pain and arm strength was performed. RESULTS A difference of more than 20 degrees in abduction, ventral elevation, or dorsal elevation occurred in 12% of the patients. Pain or loss of strength were measured in half of the patients. Shoulder movement, pain, and arm strength were not significantly different between the patients who underwent mastectomy or breast conserving surgery. Also, no significant difference could be found in shoulder movement, pain, and arm strength between the patients who underwent axillary dissection 6-12 months ago and those who underwent it more than 5 years ago. CONCLUSIONS Pain, loss of arm strength, and limitation of shoulder movement are frequent complaints after axillary dissection for breast cancer and appear to be independent of the length of follow-up and the type of surgery (i.e., breast-conservation or mastectomy).
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Affiliation(s)
- Miranda F Ernst
- Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
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13
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Grube BJ, Hansen NM, Ye W, Herlong T, Giuliano AE. Surgical management of breast cancer in the elderly patient. Am J Surg 2001; 182:359-64. [PMID: 11720671 DOI: 10.1016/s0002-9610(01)00737-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Breast cancer in the older woman is a major health issue and therapeutic challenge. This study asked if presentation, surgical treatment, and outcome of breast cancer are different in elderly women compared with their younger counterparts. METHODS There were 816 women < 70 years (younger) and 190 > or = 70 years (older) treated surgically for breast carcinoma between January 1992 and April 2000. Data for younger and older patients was analyzed from our prospective database. RESULTS More older women had mammographic lesions (P < 0.006). Breast conservation was the treatment of choice for both groups. Stage, tumor size, histology and disease-specific survival were similar for both. There was no evidence of disease in 93% of cases in the < 70 years group at median follow-up of 38.4 months and 91% for the > or = 70 years group at 44.5 months. CONCLUSIONS In our population the presentation, surgical treatment, and survival from breast cancer is similar in older and younger women.
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Affiliation(s)
- B J Grube
- Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA
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14
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Abstract
The long-term follow-up of patients treated with extended radical mastectomy has proved that the internal mammary node (IMN) status is an important prognosticator of breast cancer. Patients with isolated IMN involvement seem to have the same outcome as those with limited axillary disease, and these patients may therefore be overstaged in the TNM system. Sentinel node biopsy (SNB) of IMNs may be an ideal staging procedure, but lymphatic mapping studies demonstrate that data from extended radical mastectomy series cannot be extrapolated to patients suitable for SNB, where the IMN involvement is <5% overall, and around 1% for IMN metastases without axillary disease. Current evidence does not allow internal mammary SNB to be recommended as a standard procedure, but as patients with IMN involvement may benefit from adjuvant systemic treatment, internal mammary SNB should be further studied in this context.
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Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Nyíri út 38, POB 149, H-6000 Kecskemét, Hungary.
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15
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Voogd AC, Coebergh JW, Repelaer van Driel OJ, Roumen RM, van Beek MW, Vreugdenhil A, Crommelin MA. The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis. Breast Cancer Res Treat 2000; 62:63-9. [PMID: 10989986 DOI: 10.1023/a:1006447825160] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A population-based study was performed to assess the likelihood of axillary lymph node metastases in patients with clinically negative lymph nodes, according to patient age, tumor size and site, estrogen receptor status, histologic type and mode of detection. Data were obtained from the population-based Eindhoven Cancer Registry. During the period 1984-1997, 7680 patients with invasive breast cancer were documented, 6663 of whom underwent axillary dissection. Of the 5125 patients who were known to have clinically negative lymph nodes and underwent axillary dissection, 1748 (34%) had positive lymph nodes at pathological examination. After multivariate analysis, histologic type, tumor size, tumor site and the number of lymph nodes in the axillary specimen remained as independent predictors of the risk of nodal involvement (P < 0.001). Lower risks were found for patients with medullary or tubular carcinoma, smaller tumors, a tumor in the medial part of the breast and patients with less than 16 nodes examined. This study gives reliable estimates of the risk of finding positive lymph nodes in patients with a clinically negative axilla. Such information is useful when considering the need for axillary dissection and to predict the risk of a false-negative result when performing sentinel lymph node biopsy.
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Affiliation(s)
- A C Voogd
- Comprehensive Cancer Center South, Eindhoven, The Netherlands.
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16
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Crowe P, Temple W. Management of the axilla in early breast cancer: is it time to change tack? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:288-96. [PMID: 10779062 DOI: 10.1046/j.1440-1622.2000.01801.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The standard surgical treatment of the axilla in patients with early breast cancer is about to undergo a radical change. Although axillary dissection is an excellent procedure for both staging and local control, particularly in the clinically positive axilla, it has considerable morbidity and may understage a significant proportion of patients, because it will usually miss micrometastases that can occur in approximately 10% of 'node negative' patients. An increasing number of patients whose tumours are either non-invasive (ductal carcinoma in situ; DCIS), micro-invasive, tubular cancers or low-grade T1a tumours without lymphovascular invasion may be spared axillary surgery because the risk of axillary disease is 0-3%. Many studies, both prospective trials and large retrospective series, show that axillary radiotherapy alone provides similar local control rates to axillary dissection in patients with clinically negative axillas. Primary treatment of the axilla with radiotherapy alone, however, does not allow appropriate staging. Sentinel lymph node biopsy is being increasingly used in patients with breast cancer to provide this information. When a sentinel node is identified it is equal to or better than axillary dissection for staging the axilla and, if the node is positive, it will help select patients who should then proceed to further axillary surgery or axillary radiotherapy. Although sentinel lymph node biopsy is being rapidly adopted in many centres worldwide, the results of randomized controlled trials are needed before it can be recommended as the standard of care.
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Affiliation(s)
- P Crowe
- Tom Baker Cancer Centre, Calgary, Alberta, Canada.
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17
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Abstract
Radiotherapy has a major role in the multidisciplinary approach to cancer therapy. It is widely used for curative and palliative treatment of cancer involving various sites. Radiotherapy is of particular benefit to older and frail cancer patients as an alternative to surgery and to systemic therapy. The available data on the sensitivity of normal tissues to radiotherapy in elderly patients strongly suggest that older patients with good functional status tolerate radiotherapy as well as younger patients and have comparable tumor response and survival rates. Aggressive radiotherapy should not be withheld from older patients because of chronological age alone.
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Affiliation(s)
- B Zachariah
- Department of Radiology, University of South Florida College of Medicine, USA
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18
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Ashkanani F, Eremin O, Heys SD. The management of cancer of the breast in the elderly. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:396-402. [PMID: 9800967 DOI: 10.1016/s0748-7983(98)92124-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast cancer in older women continues to be a clinical problem and therapeutic challenge. The clinical presentation, biological characteristics and survival rates are comparable between older and younger women with breast cancer. Treatment of breast cancer in older women should aim to ensure satisfactory control of locoregional disease and prolongation of survival, for as long a period as possible. Optimal surgical therapy should be as for younger patients and adjuvant therapies may be required (considering side-effects and benefits). However, randomized trials are required to clarify the role of adjuvant treatments in older patients.
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Affiliation(s)
- F Ashkanani
- Department of Surgery, University Medical Buildings, Aberdeen, UK
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19
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Cserni G. The impact of axillary lymphadenopathy on further treatment in breast cancer? A model for clinical staging. Pathol Oncol Res 1998; 4:301-3. [PMID: 9887361 DOI: 10.1007/bf02905221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical assessment is an important part of the breast cancer patients' work-up, but it has low sensitivity and specificity. In a retrospective study, histological slides of axillary clearance specimens were used to model palpability of the axillary lymph nodes. Obvious nodes (enlarged and involving considerable amount of lymphatic and/or metastatic tissue) and nodes equal to or larger than 1 cm or 1.5 cm were counted and the slides were subsequently reviewed. The false positive and negative rates expected on the basis of the model ranged from 24 to 72 % and from 10 to 38 %, respectively. This model (also valid for intraoperative assessment of nodal status by palpation) documents the lack of specificity of clinical staging of the axilla. These results question the practice of excluding patients with palpable axillary lymph node enlargement from less radical staging procedures such as axillary sampling or sentinel node biopsy.
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Affiliation(s)
- G Cserni
- Department of Pathology, Bács-Kiskun County Hospital, Kecskemét,
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