Lumpectomy without Radiation an Option for Some Older Breast Cancer Patients

Among women aged 70 or older with Stage I, estrogen receptor-positive breast cancer, treatment with lumpectomy and tamoxifen resulted in a higher rate of cancer recurrence but similar overall survival as treatment with lumpectomy, tamoxifen, and radiation therapy. These results, which will be presented at the 2010 annual meeting of the American Society of Clinical Oncology, suggest that some older women may be able to forego radiation therapy without adversely affecting survival.

Surgery for early-stage breast cancer typically involves either mastectomy or lumpectomy. A mastectomy involves removal of the entire breast, whereas a lumpectomy involves removal of the cancer and a portion of surrounding tissue.? Because a lumpectomy alone is associated with a higher rate of cancer recurrence than mastectomy, patients who elect to have a lumpectomy are generally also treated with radiation therapy. The combination of lumpectomy and radiation is called breast-conserving therapy. Studies have shown that breast-conserving therapy is associated with a lower risk of local cancer recurrence than lumpectomy alone.

Although the addition of radiation therapy to lumpectomy reduces the risk of local cancer recurrence, radiation therapy typically takes place over several weeks and requires a large commitment of time from the patient. This has prompted interest in whether there are certain groups of women with early breast cancer who can safely forego radiation therapy after lumpectomy.

The current study involved 636 women aged 70 or older with Stage I, estrogen receptor-positive breast cancer. After lumpectomy, women were assigned to additional treatment with tamoxifen alone or tamoxifen plus radiation therapy.

Women have now been followed for over 10 years.

The risk of cancer recurrence in the same breast was lower among women who received radiation therapy: a local cancer recurrence developed in 2% of women treated with tamoxifen and radiation therapy and 8% of women treated with tamoxifen alone.Breast cancer-specific and overall survival were similar in the two study groups: 10-year overall survival was 61% among women treated with tamoxifen and radiation therapy and 63% in women treated with tamoxifen alone.

These results suggest that among older women treated with lumpectomy and tamoxifen for Stage I, estrogen receptor-positive breast cancer, skipping radiation therapy increases the risk of local cancer recurrence but does not adversely affect overall survival.

Older women with early breast cancer may wish to talk with their doctor about the risks and benefits of all treatment options.

Reference: Hughes KS, Schnaper LA, Cirrincione C et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer. To be presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract 507.

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Outcomes in Older Women with Breast Cancer

Among postmenopausal women with hormone receptor-positive breast cancer, the likelihood of dying from breast cancer increases with age. These results were published in the Journal of the American Medical Association. ?

Of the more than 200,000 cases of breast cancer diagnosed each year in the United States, roughly 40 percent occur in women over the age of 65. Research that explores how breast cancer outcomes change as women age has the potential to improve care for this large group of women.?

To evaluate breast cancer outcomes by age, researchers analyzed information from a clinical trial known as TEAM (Tamoxifen, Exemestane, Adjuvant, Multinational). The study enrolled more than 9,700 postmenopausal women with non-metastatic, hormone receptor-positive breast cancer. All women were treated with surgery and hormonal therapy. Decisions about chemotherapy and/or radiation therapy were left to the treating physician.?

Women were followed for just over five years.?

Death from breast cancer occurred in 5.7 percent of women under the age of 65, 6.3 percent of women between the ages of 65 and 74, and 8.3 percent of women age 75 or older.?Older women continued to be more likely to die from breast cancer even after the researchers accounted for tumor characteristics and other factors known to affect outcomes.??

One of the possible explanations for the worse breast cancer outcomes among older women involves treatment. Studies have suggested that older women are less likely than younger women to received standard breast cancer treatments, possibly due to concern that about the ability of older women to tolerate these treatments. In the current study, for example, 48 percent of the oldest women had breast cancer that had spread to the lymph nodes, but only 5 percent received chemotherapy. Older women were also less likely than younger women to receive radiation therapy after a lumpectomy.?

Although older women in this study were more likely to die of breast cancer than younger women, it should be noted that most women—regardless of their age—did not die of breast cancer. It should also be noted that all of the women in this study were postmenopausal. This study did not address cancer outcomes in premenopausal women.?

Reference: van de Water W, Markopoulos C, van de Velde CJH et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307:590-597.?

Posted February 10, 2012

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Older Chemotherapy Regimen for Breast Cancer Linked with Persistent “Chemo Brain”

Women who received CMF chemotherapy for breast cancer between 1976 and 1995 scored slightly lower than women with no history of cancer on tests of word learning, memory, and information processing. These results were published in the Journal of Clinical Oncology.?

Studies of “chemo brain”—the foggy thinking and forgetfulness that patients may experience after chemotherapy—have suggested that the condition often improves with time. Some patients, however, may experience persistent problems.?

CMF is a chemotherapy regimen that was once commonly used in the treatment of breast cancer. It involves a combination of cyclophosphamide, methotrexate, and 5-fluorouracil. ?

To explore long-term effects of CMF on cognitive function, researchers in Europe conducted a study among 196 breast cancer survivors who had been treated with CMF between 1976 and 1995. The cognitive function of these women was compared with the cognitive function of more than 1,500 women who had never had cancer.?????

The cognitive test scores of the women who had been treated with CMF were slightly lower than the scores of the women who had never had cancer. Scores were lower in the areas of word learning, memory, and information processing speed. ?The reduction in test scores among the CMF-treated women was comparable to roughly six years of age-related cognitive decline.?

Although CMF is given less frequently than in the past, it is still used in some patients.? It is not known how other chemotherapy regimens affect long term cognitive function.? For women who are experiencing subtle but persistent cognitive problems, coping strategies—such as developing systematic daily routines and preparing well for activities such as work or travel—may be helpful.????

Some people appear to be more likely than others to experience long-term cognitive problems after chemotherapy, and researchers are looking into the reasons for this.?

Reference: Koppelmans V, Breteler MMB, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. Journal of Clinical Oncology. Early online publication February 27, 2012.?

Posted March 1, 2012

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Diagnosis of Early Breast Cancer Doesn’t Shorten Life Expectancy of Older Women

Among women age 67 or older, a diagnosis of ductal carcinoma in situ (DCIS) or Stage I breast cancer doesn’t appear to worsen survival; survival is similar to that of older women without breast cancer. Diagnosis of more advanced breast cancer, however, is linked with worse survival. These results were published in the Journal of Clinical Oncology.

Older women are a rapidly expanding segment of the U.S. population. The incidence of breast cancer increases with age, but it’s been uncertain how a diagnosis of breast cancer (particularly early-stage breast cancer) affects life expectancy among older women.

To explore the impact of a breast cancer diagnosis on the survival of older women, researchers conducted a study among more than 64,000 women who had been diagnosed with breast cancer at age 67 or older. Survival in these women was compared with survival in a group of similarly aged women without breast cancer. In the analysis, the researchers accounted for the other health problems, prior mammography use, and sociodemographic variables.??

Women who were diagnosed with DCIS or Stage I breast cancer and received standard treatment had similar survival to women without breast cancer. The most common cause of death among women with DCIS or Stage I breast cancer was cardiovascular disease. Women with Stage II or higher breast cancer had shorter survival than women without breast cancer. Risk of death was 50% higher among women with Stage II breast cancer, three-times higher among women with Stage III breast cancer, and close to 10-times higher among women with Stage IV breast cancer. The survival differences between women with advanced breast cancer and women without breast cancer decreased with age.

These results suggest that among older women, a diagnosis of DCIS or Stage I breast cancer does not shorten life expectancy.

Reference: Shonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP. Causes of death and relative survival of older women after a breast cancer diagnosis. Journal of Clinical Oncology. Early online publication March 14, 2011.

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