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Is Breast Cancer Slow Growing In The Elderly

Calculating Risk Based On Tumor Size

New Frontiers in Hormone Therapy for Breast Cancer

Memorial Sloan Kettering Cancer Center provides a Breast Cancer Nomogram through which you can predict the likelihood that a breast cancer has spread to axillary lymph nodes based on tumor size .

To complete this estimate, you are asked to agree to the conditions, and understand that it is only an estimate.

Cellular Changes And Aging

With aging, some cells achieve proliferative senescence, remaining biologically active without cell division. Replicative senescence has been documented in stromal fibroblasts in vitro cells undergo a finite number of divisions and then enter a state of irreversibly arrested cell growth. These cells are resistant to apoptosis, release tumor growth factors and enzymes, and are vulnerable to cellular dysregulation. If cells escape from this regulated environment, they may be highly susceptible to malignant transformation. These characteristics may provide a favorable environment for carcinogenesis and tumor growth.

Age-related alterations in growth factor production and activity, metalloproteinase expression, hormonal status, inflammation, and immune cell number and function may contribute to changes in tumor biology and expression of cancers in the elderly.

Treatment And Patient Related Quality Of Life Issues In Elderly And Very Elderly Breast Cancer Patients

Beng├╝ Depboylu

Department of Radiation Oncology, Faculty of Medicine , , Turkey

Correspondence to:

Abstract: As the number of aging population increases, a significant amount of elderly cancer patients need more personalized care for their cancer treatment. Breast cancer is the most common cancer in women, and almost half of the newly diagnosed patients are older than the age of 65 years. With their peculiar characteristics, elderly patients with breast cancer should be held with a comprehensive geriatric assessment. It is vital to make the choice of correct treatment more delicately, to better predict the prognosis of the patient and risks associated with specific treatments. The current article focuses on how various methods of treatment in elderly breast cancer affect their quality of life and the challenges they experience among age from 70 to 79 and age from 80 and over subgroups of this population. Treatment and patient-related quality of life issues are revisited in the light of recent literature.

Keywords: Breast cancer elderly frailty geriatric assessment quality of life

Submitted Jun 15, 2019. Accepted for publication Jul 01, 2019.

doi: 10.21037/tcr.2019.07.08

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Never Too Old To Fight Cancer

As the number of elderly patients with cancer soars, researchers explore how best to treat them

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For my hale and hearty father-in-law, the first sign that something was wrong occurred at 88 years of age, when his ever reliable tennis serve kept landing astray. A series of medical tests soon revealed the worst: advanced, metastatic pancreatic cancer. Treatment might buy him a little time, his doctors told him, but that prospect did not outweigh his dread of spending his final days in a toxic and debilitating haze of chemotherapy. He quickly opted for hospice care and died with dignity less than two months later, surrounded by loved ones.

My own father learned he had bladder cancer at 91 and made a very different choice. He underwent the full trifecta of treatment: surgery to pare down a tumor that had already penetrated the bladder wall, plus seven weeks of chemotherapy and 35 radiation treatments to destroy lingering cancer cells. There were times when he regretted it, complaining of weakness and torpor, but 20 months after completing the clinical gauntlet, he is alive and going relatively strong, considering he is 93. His sister made a similar decision when faced with lymphoma at 88 she, too, is a survivorat 91.

SCIENTIFIC AMERICAN ONLINELearn about Arti Hurria’s 11-question scoring tool at ScientificAmerican.com/dec2014/soh

This article was originally published with the title “Never Too Old for Chemo” in Scientific American 311, 6, 34-35

Personal History Of Breast Disease

PPT

Females who have previously had breast cancer are at risk of developing a second breast cancer, either in the other breast or in a different part of the same breast. This is not the same as the first cancer returning.

Having a personal history of certain noncancerous breast conditions can also increase a persons risk of breast cancer. This can include conditions such as atypical hyperplasia, lobular carcinoma in situ, and ductal carcinoma in situ.

People with a history of breast, ovarian, fallopian tube, or peritoneal cancer should ask their doctors about .

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Barriers To Cancer Therapies

When discussing therapeutic options, all parties must be included in the discussion. Each partys perspective must be reviewed within the context of disease- and age-related factors. One must be conscientious of the fact that older patients may defer to family members or a physician thus, masking their own wishes. Patient, physician and family biases may contribute to inappropriate staging and treatment decisions.

  • Patients perspective:
  • Increased pessimism: Cancer is contagious, Cancer is incurable even when diagnosed at early stages, and Treatment for cancer is worse than the disease itself
  • Less general health knowledge and literacy than younger patients
  • Less assertive in therapeutic triad and decision making
  • Emphasize desire not to be a burden
  • As likely to agree to curative treatment but quality more than quantity of life influences decision making
  • Coping skills are more refined than younger patient
  • Caregivers perspective
  • Role as protector Versus caregiver Versus child or spouse
  • Limit emotional and physiologic stress on family member
  • Concern for caregiver stress
  • Limit emotional and physiologic stress on patient and family
  • Resource utilization
  • Principles of paternalism and ageism often color assessment and decision making
  • Lack of data impacts decision process
  • Can You Do Anything To Prevent Or Slow The Spread Of Breast Cancer

    Like any type of cancer, there are factors that can put you at higher risk. For breast cancer, these include things like smoking, unhealthy diet, lack of exercise and not performing monthly self-breast exams. Its also important to make sure and get your annual mammogram for breast cancer screening.

    Other risk factors can include using hormone-based prescriptions, how many children youve had in the past, getting older and at what age you got your period and went through menopause.

    In some instances, you cant necessarily prevent breast cancer, but you can sometimes slow it down, stop it from spreading or reduce the size of the tumor, says Dr. Roesch. You can do this by taking your medications as directed, following through with treatments, going to your appointments and being involved in your cancer care.

    Youre in control of taking your medication correctly, eating a healthy diet, participating in an exercise program and managing stress. All of these things can contribute to a stronger physical body and better mental attitude both of which can have a positive impact on your breast cancer diagnosis.

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    Specific Markers Able To Evaluate Response To Therapies

    Neopterin is a pteridin catabolic product of guanosine triphosphate , a purine nucleotide. It is synthesized by macrophages upon stimulation with the cytokine interferon-gamma and is indicative of a pro-inflammatory immune status so that it can be a marker of cellular immune system activation. Neopterin has been known for long time as a marker of immunological distress, linked to viral infections, like cytomegalovirus, or cancer. Its relationship with breast cancer has been evidenced principally for metastatic cancer .

    Urinary neopterin has shown increased in about 20% of breast cancer patients, and a recent study has revealed its increase to be linked to age, 70 years or older, and to comorbidities . Two or more comorbidities had a cumulative effect and were associated with higher levels of neopterin .

    Risk Factors Of Cancers

    Breast Cancer in Elderly Women: Treatment Options

    Age in itself significantly increases the risk of cancer. Also other risks associated with lifestyle accumulate in the elderly. However, it is never too late to make healthy lifestyle changes. Thus quitting smoking, limiting alcohol use, favoring a vegetable-rich diet, weight control, and physical activity may all be recommended to the elderly.

    A healthy lifestyle improves overall health comprehensively, which helps older people maintain better well-being. Good general condition and muscle strength, independence, as well as controlled diabetes and blood pressure can decisively work in favor of active treatment, if the patient is for example about to have a large operation of the abdominal cavity or lungs, and removing the cancer completely would be possible.

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    What Stages Have To Do With Cancer Spread

    Cancers are staged according to tumor size and how far it has spread at the time of diagnosis. Stages help doctors decide which treatments are most likely to work and give a general outlook.

    There are different types of staging systems and some are specific to certain types of cancer. The following are the basic stages of cancer:

    • In situ. Precancerous cells have been found, but they havent spread to surrounding tissue.
    • Localized. Cancerous cells havent spread beyond where they started.
    • Regional. Cancer has spread to nearby lymph nodes, tissues, or organs.
    • Distant. Cancer has reached distant organs or tissues.
    • Unknown. Theres not enough information to determine the stage.
    • Stage 0 or CIS. Abnormal cells have been found but have not spread into surrounding tissue. This is also called precancer.
    • Stages 1, 2, and 3. The diagnosis of cancer is confirmed. The numbers represent how large the primary tumor has grown and how far the cancer has spread.
    • Stage 4. Cancer has metastasized to distant parts of the body.

    Your pathology report may use the TNM staging system, which provides more detailed information as follows:

    T: Size of primary tumor

    • TX: primary tumor cant be measured
    • T0: primary tumor cant be located
    • T1, T2, T3, T4: describes the size of the primary tumor and how far it may have grown into surrounding tissue

    N: Number of regional lymph nodes affected by cancer

    M: Whether cancer has metastasized or not

    How To Get Screened For Breast Cancer

    If you notice youve experienced some of the symptoms of senior breast cancer, visit the doctor as soon as possible. Not next week, not next month. As soon as the doctor can fit you in. When making the appointment, you should note you the symptoms you have experienced. You should also get a yearly test even if you arent showing any symptoms.

    Your doctor will perform a handful of tests to determine if your symptoms are the result of the presence of cancer in your breasts. Some of these tests include:

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    Menstrual And Reproductive History

    The menstrual cycle increases levels of the female sex hormones estrogen and progesterone in the body.

    Starting menstrual periods at a younger age or going through menopause at a later age raises the bodys exposure to these hormones, which can increase a persons risk of breast cancer.

    Those who start their menstrual period before the age of 12 years and those who go through menopause after the age of 55 years have an increased risk of breast cancer.

    Females who have never given birth at full-term and those who had their first full-term pregnancy after the age of 30 years also have a higher risk of breast cancer, according to the NCI.

    Axillary Lymph Node Status

    Breast cancer hope as hormone shown to slow tumour growth ...

    Axillary nodal status is known to be the principal prognostic factor.

    Many women in older age are deprived of this tool, mainly for three reasons: 1) Comorbidities affecting the possibility of adjuvant therapy 2) a poor life expectancy 3) avoidance of morbidity related to axillary surgery. Martelli et al, have studied the possibility to spare lymphectomy to older women in a randomized trial on 219 women aged 65-80, with early BC. They found just a 2% of clear axillary metastatic involvement at 5-years follow up . A survey on the same sample at 15 years follow up showed no differences in OS between patients undergone axillary dissection and those who did not . Only few studies include longer than 5-years follow up in patients with early stage cancer but, as already observed, it is difficult to find longer follow-ups in this class of age .

    Albrand and Terret in their review agreed with the SIOG recommendation to treat axillary node in the elderly not differently than in younger women .

    Since sentinel node biopsy has been introduced, at least for suitable patients , the axillary morbidity should no longer be a problem .

    Various other scoring systems have been proposed to simplify and improve the predictivity of this procedure. All these tools have been compared with the MSKCC nomogram. Among these, the Turkish score , the Cambridge nomogram , the Mayo nomogram , the Tenon score and the Stanford online calculator .

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    Review Articlebreast Cancer Treatment In Women Over The Age Of : A Tailored Approach

    12% of all breast cancer cases occur in women over 80 years of age.

    Treatment plans for breast cancer in octogenarians should consider co-morbidities.

    Online tools can assess life expectancy and benefits and risks of cancer therapies.

    Surgical therapy is well tolerated in octogenarians and should not be underutilized.

    Axillary staging and radiation therapy may be omitted in some cases.

    Causes Of Breast Cancer

    Breast cancer is caused by a mutation of cells in the breast, but its not exactly clear what causes that mutation. Whereas with lung cancer, for example, its easier to point to an activity like smoking as the root cause, the same does not hold true for breast cancer.

    However, there are risk factors for senior breast cancer and they include:

    Recommended Reading: Anne Hathaway Breast

    Can You Tell When Exactly My Breast Cancer Started

    Often times, one of the most frequently asked questions I get when someone is diagnosed with breast cancer is when did it begin? says Roesch. And the general rule is that we really cant tell for sure when the cancer popped up. We can look at the subtype of breast cancer to perhaps get a better understanding if it was weeks vs. months for example, but theres no way to tell for sure.

    Physiologic Changes And Aging

    Prediction Of Stage Four Breast Cancer Progression

    There is an age-related change in homeostatic and allostatic processes physiologic and functional reserves are diminished, and are often maintained in a fragile balance. Decreases in stem cell reserve, less efficient cellular repair mechanisms, and diminished organ tissue and function coupled with age-related comorbidities, altered catabolism of drugs, and increased exposure to reactive species, carcinogens and stressors, render older adults vulnerable to treatment-related toxicities.

    Physiologic Change
    • increased elimination of Rx from cancer cells
    • increased indolent behavior of tumor

    Pharmacokinetics is the effect of bodily processes on the drug. PK is impacted by body composition, bioavailability and organ function.

    • Body composition changes with age
    • Fat distribution increases 2-fold and total body water decreases 10-15% with age,
    • Volume of distribution increases for lipophilic drugs and declines for hydrophilic drugs,
    • Increased age- and disease-related risk for anemia and hypoalbuminemia coupled with changes in TBW lead to alterations in drug binding, peak concentrations and half-life of chemotherapeutic agents.
  • Bioavailability is dependent on gastrointestinal motility, splanchnic blood flow, digestive enzyme activity and mucosal integrity, all of which may be altered with age, especially if age > 80 years
  • Age-related loss of kidney and liver organ function may impact drug dosing and tolerability due to changes in metabolism and excretion of drug.
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    Good News And Bad News About Breast Cancer

    Women are more alarmed than they need to be about the chances that they will develop breast cancer. But they are also more confident than they should be that the advances medicine has made in treating the disease and prolonging life mean that it can be cured

    Few things frighten a woman more than discovering a lump in one of her breasts. With good reason: breast cancer may transform a woman’s breast into the vehicle of her death. It is twice as likely to be diagnosed in an American woman today as it was sixty years ago. And the treatmentsurgery, usually followed by radiation and chemotherapyis disfiguring, painful, and all too often unsuccessful.

    I have been researching and treating this disease for more than thirty-five years, a period in which the public’s awareness of breast cancer has risen enormously. The disease has brought into being an entire industry of research organizations, charitable agencies, commercial ventures, and advocacy groups. Every new statistic is trumpeted in the media, and every encouraging research finding, no matter how tenuous, is held up as a potential breakthrough.

    IS BREAST CANCER AN EPIDEMIC?

    To our grandparents, this picture would have seemed amazing. At the turn of the century cancer of the breast was a relatively unusual disease. What happened? Why does the incidence of breast cancer seem so much higher today?

    BREAST-CANCER BASICS DOES MAMMOGRAPHY HELP?STATISTICAL TROUBLESARE WE CURING BREAST CANCER? ANOTHER VIEW OF BREAST CANCER

    Breast Cancer Cell Growth

    Cancer begins when a normal breast cell undergoes a number of mutations in genes that control the growth of the cell. These mutations may occur over a long period of time, even decades, before a cancer cell forms.

    A cancer cell must divide on average 30 times before it forms a mass that can be felt in the breast. Since tumor cells multiply and divide exponentiallyone cell becomes two, two cells become four, and so ona tumor will increase more rapidly in size the larger it is.

    That said, not all cells are dividing at one time, and growth can be different at different stages in the formation of a tumor. Compared with many types of cancer, breast cancer has a “low growth fraction,” meaning that the proportion of cancer cells that are in an active cell cycle is low.

    Some tumors, such as some leukemias and lymphomas, have much higher growth fractions .

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