Management of Elderly Breast Cancer Patients Referred to the Cancer Institute of Iran during 2000-2014: Call For a National Guideline
AbstractBackground: About one-third of the total breast cancer occurs in women over 65 years of age. Elderly breast cancer management is one of the worldwide oncology challenges. Unlike radical treatment of younger women’s mammary tumors, the type of treatment in elderly breast cancer is based on life expectancy. The present study aimed to determine the clinical and pathological characteristics of elderly breast cancer in Iranian patients and to identify modal treatment differences with developed countries. Methods: A total of 239 cases of breast cancer patients over 65 years referred the Cancer Institute of Iran between 2000 and 2014 was studied and the demographic, pathologic, surgical, and adjuvant therapy data were recorded. In addition, two parameters of recurrence and disease free survival (DFS) were analyzed statistically. Results: The mean age of patients was 71.8±6.15 and invasive ductal carcinoma (IDC) was the most abundant tumor. In terms of tumor size, T2 was 52.5% and in terms of axillary lymph node involvement, N1 was 53.2%. Stage II has the highest rate and metastasis was occurred in 16% of patients in follow up. Hormone receptors were positive in 74.2% and HER-2 in 33.1%. In terms of treatment, 64.6% of patients underwent modified radical mastectomy (MRM), 76.8% chemotherapy, 75.1% radiotherapy, and 54% hormone therapy. In 54-month follow-ups, local and systemic recurrence occurred in 27 patients, in most of the cases in the first 4 years; 79 patients died of cancer during the same period. Conclusion: Our results showed that tumors stage was higher than similar studies, and despite the radical regimen strategies in Iran, the risk of recurrence and mortality was higher. Therefore, it is suggested to repeat the study in other major treatment centers in Iran. We suggest perform the treatment of elderly breast cancer based on a multidisciplinary team, and to develop national guidelines for these patients.
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