Abstract
BACKGROUND
The authors evaluated the two indicators of metastatic proclivity (namely, virulence [V; the rate of appearance of distant metastases] and metastagenicity [M; the ultimate likelihood of developing distant metastases]) of breast carcinoma in elderly women. The authors then compared these characteristics with the corresponding characteristics in a cohort of younger women to determine whether breast carcinoma was more indolent in women age > 70 years, as is commonly believed in the medical community.
METHODS
The authors examined 2136 women who underwent mastectomy without adjuvant systemic therapy at The University of Chicago Hospitals (Chicago, IL) between 1927 and 1987. The median followโup period was 12.3 years. Distant diseaseโfree survival (DDFS) was determined for women who did not receive systemic therapy. V and M were obtained from logโlinear plots of DDFS.
RESULTS
No significant difference in tumor size at presentation was observed among women age < 40 years, women ages 40โ70 years, and women age > 70 years (P = 0.86), whereas significantly fewer women age > 70 years presented with positive lymph nodes compared with younger women (P = 0.05). In women with negative lymph node status, there was a higher DDFS rate among patients ages 40โ70 years (81% at 10 years) compared with patients age > 70 years (65% at 10 years; P = 0.018). There was no significant ageโrelated difference among women with lymph nodeโpositive disease (P = 0.2). For example, the 10โyear DDFS rate for women ages 40โ70 years was 33%, compared with 38% for women age > 70 years. Among those with lymph nodeโnegative disease, V was 3% per year for women ages 40โ70 years as well as women age > 70 years. Among women with lymph nodeโnegative disease, M was 0.20 for patients ages 40โ70 years and 0.35 for patients age > 70 years. In women with positive lymph node status, both V (11% per year vs. 10% per year) and M (0.70 vs. 0.65) were similar in both age groups.
CONCLUSIONS
Fewer women age > 70 years had lymph node involvement at presentation. However, when this finding was taken into account, the authors found no evidence that breast carcinoma was more indolent in women age > 70 years. These results support the use of similar diagnostic and therapeutic efforts for elderly women and younger women, with modification for elderly women based only on comorbidity. Cancer 2004. ยฉ 2004 American Cancer Society.