J Breast Cancer.  2012 Sep;15(3):296-305. 10.4048/jbc.2012.15.3.296.

Adjuvant Chemotherapy and Survival of Elderly Korean Patients with Breast Carcinoma

• Jung SP
• Lee JE
• Lee SK
• Kim S
• Choi MY
• Bae SY
• Kim J
• Kil WH
• Choe JH
• Kim JH
• Kim JS
• Nam SJ

• KMID: 2286455
• DOI: http://doi.org/10.4048/jbc.2012.15.3.296

Abstract

PURPOSE
The available research work on types of treatment and the efficacy of adjuvant chemotherapy in older Korean patients is insufficient. Henceforth, this report assessed treatment patterns and the relationship between chemotherapy and survival in elderly Korean breast cancer patients.
METHODS
We identified women over 55 years of age diagnosed with breast cancer from the period 1995 to 2006. Clinicopathologic features and treatment methods were compared for three groups divided on the basis of age: 55 to 59 years, 60 to 69 years, and over 70 years old. The effects of chemotherapy on survival were compared overall and individually for each group.
RESULTS
A total of 832 patients over 55 years of age were included in the present investigation. No statistical differences were observed between the three age groups in clinicopathologic features including tumor size, grade, and stage. However, patients in the elderly group received mastectomy more often when compared to the younger groups (p<0.001). In contrast, there was a decline in radiation treatment and chemotherapy with older age (p<0.001). Overall, patients who received chemotherapy had a significantly increased breast cancer specific survival and overall survival rate when compared to the non-chemotherapy groups (p=0.022). Among the estrogen receptor positive group, no statistical significance was achieved in the survival benefit of chemotherapy. However, in estrogen receptor-negative patients, overall, the chemotherapy groups showed a better survival rate than the non-chemotherapy patients and a similar trend was observed in each age group except in the group comprising of 70 years old patients.
CONCLUSION
This study describes the survival benefit of adjuvant chemotherapy in Korean patients over 55 years of age, especially in hormone receptor-negative patients. Hence, based on the results of the present report and considering the similarity of clinicopathologic features between age groups, it is proposed that age alone should not be a determinant factor of treatment methods.

Keyword

Aged; Breast; Carcinoma; Chemotherapy; Survival

MeSH Terms

Aged
Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Estrogens
Female
Humans
Mastectomy
Survival Rate
Estrogens

Figure

• 

  Figure 1 Cumulative incidence of breast cancer-specific mortality. (A) Total population. (B) Subgroup by age.

• 

  Figure 2 Survival results by chemotherapy. (A) Disease-specific survival of total patients. (B) Disease-specific survival of 55 to 59 years group. (C) Disease-specific survival of 60 to 69 years group. (D) Disease-specific survival of ≥70 years group. (E) Overall survival of total patients. (F) Overall survival of 55 to 59 years group. (G) Overall survival of 60 to 69 years group. (H) Overall survival of ≥70 years group. CTx+=chemotherapy received group; CTx-=chemotherapy non-received group.

• 

  Figure 3 Survival results by chemotherapy in estrogen receptor-positive patients. (A) Disease-specific survival of total patients. (B) Disease-specific survival of 55 to 59 years group. (C) Disease-specific survival of 60 to 69 years group. (D) Disease-specific survival of ≥70 years group. (E) Overall survival of total patients. (F) Overall survival of 55 to 59 years group. (G) Overall survival of 60 to 69 years group. (H) Overall survival of ≥70 years group. CTx+=chemotherapy received group; CTx-=chemotherapy non-received group.

• 

  Figure 4 Survival results by chemotherapy in estrogen receptor-negative patients. (A) Disease-specific survival of total patients. (B) Disease-specific survival of 55 to 59 years group. (C) Disease-specific survival of 60 to 69 years group. (D) Disease-specific survival of ≥70 years group. (E) Overall survival of total patients. (F) Overall survival of 55 to 59 years group. (G) Overall survival of 60 to 69 years group. (H) Overall survival of ≥70 years group. CTx+=chemotherapy received group; CTx-=chemotherapy non-received group.

Reference

1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011. 61:212–236.

2. Yoo KY, Kang D, Park SK, Kim SU, Shin A, Yoon H, et al. Epidemiology of breast cancer in Korea: occurrence, high-risk groups, and prevention. J Korean Med Sci. 2002. 17:1–6.

3. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011. 43:1–11.

4. Leonard R, Ballinger R, Cameron D, Ellis P, Fallowfield L, Gosney M, et al. Adjuvant chemotherapy in older women (ACTION) study: what did we learn from the pilot phase? Br J Cancer. 2011. 105:1260–1266.

5. Gennari R, Curigliano G, Rotmensz N, Robertson C, Colleoni M, Zurrida S, et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopasual patients. Cancer. 2004. 101:1302–1310.

6. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011. 61:69–90.

7. Health of the elderly. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1989. 779:1–98.

8. Yoo KY, Kim Y, Park SK, Kang D. Lifestyle, genetic susceptibility and future trends of breast cancer in Korea. Asian Pac J Cancer Prev. 2006. 7:679–682.

9. Singh R, Hellman S, Heimann R. The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer. 2004. 100:1807–1813.

10. Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000. 92:550–556.

11. Bernardi D, Errante D, Gallligioni E, Crivellari D, Bianco A, Salvagno L, et al. Treatment of breast cancer in older women. Acta Oncol. 2008. 47:187–198.

12. Giordano SH, Hortobagyi GN, Kau SW, Theriault RL, Bondy ML. Breast cancer treatment guidelines in older women. J Clin Oncol. 2005. 23:783–791.

13. Elkin EB, Hurria A, Mitra N, Schrag D, Panageas KS. 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.

14. Muss HB. Factors used to select adjuvant therapy of breast cancer in the United States: an overview of age, race, and socioeconomic status. J Natl Cancer Inst Monogr. 2001. 52–55.

15. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005. 365:1687–1717.

16. Woodard S, Nadella PC, Kotur L, Wilson J, Burak WE, Shapiro CL. Older women with breast carcinoma are less likely to receive adjuvant chemotherapy: evidence of possible age bias? Cancer. 2003. 98:1141–1149.

17. Du X, Goodwin JS. Increase of chemotherapy use in older women with breast carcinoma from 1991 to 1996. Cancer. 2001. 92:730–737.

18. Choi Y, Kim YJ, Shin HR, Noh DY, Yoo KY. Long-term prediction of female breast cancer mortality in Korea. Asian Pac J Cancer Prev. 2005. 6:16–21.

19. Park SK, Kim Y, Kang D, Jung EJ, Yoo KY. Risk factors and control strategies for the rapidly rising rate of breast cancer in Korea. J Breast Cancer. 2011. 14:79–87.

20. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010. 17:1471–1474.

21. Lee JH, Yim SH, Won YJ, Jung KW, Son BH, Lee HD, et al. Population-based breast cancer statistics in Korea during 1993-2002: incidence, mortality, and survival. J Korean Med Sci. 2007. 22:Suppl. S11–S16.

22. Kim SH, Kim MH, Oh KK. Analysis and comparison of breast density according to age on mammogram between Korean and Western women. J Korean Radiol Soc. 2000. 42:1009–1014.

23. McCormack VA, dos Santos Silva I. Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2006. 15:1159–1169.

24. Suh JS, Yoo KY, Kwon OJ, Yun IJ, Han SH, Noh DY, et al. Menstrual and reproductive factors related to the risk of breast cancer in Korea. Ovarian hormone effect on breast cancer. J Korean Med Sci. 1996. 11:501–508.

25. Herbsman H, Feldman J, Seldera J, Gardner B, Alfonso AE. Survival following breast cancer surgery in the elderly. Cancer. 1981. 47:2358–2363.

26. Pierga JY, Girre V, Laurence V, Asselain B, Diéras V, Jouve M, et al. Characteristics and outcome of 1755 operable breast cancers in women over 70 years of age. Breast. 2004. 13:369–375.

27. Giordano SH, Duan Z, Kuo YF, Hortobagyi GN, Goodwin JS. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol. 2006. 24:2750–2756.

28. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, et al. Results of the ATAC (arimidex, tamoxifen, alone or in combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 2005. 365:60–62.

29. Biganzoli L, Goldhirsch A, Straehle C, Castiglione-Gertsch M, Therasse P, Aapro M, et al. Adjuvant chemotherapy in elderly patients with breast cancer: a survey of the Breast International Group (BIG). Ann Oncol. 2004. 15:207–210.