Clinical features and prognosis in breast cancer patients over 70 years of age

OBJECTIVE: To investigate the clinical characteristics and prognostic factors in breast cancer patients over 70 years of age. METHODS: From 1980 to 2003, 280 female breast cancer patients over 70 years old were treated and the data were retrospectively reviewed. The clinical features including age, comorbidity, initial symptom, tumor size and location, pathological type, lymph node status, hormonal receptor status, treatment approaches and overall survival were analyzed. RESULTS: These 280 patients accounted for 2.9% of all breast cancer patients registered in our institution during the same period. Presentation of breast lump as initial symptom accounted for 92.5% of the patients. The median time from the presentation of initial symptom to initial diagnosis was 4 months. Major pathological type was invasive ductal carcinoma (74.3%). Estrogen or progesterone receptor was found to be positive in 72.9% by immunohistochemical staining. 165 patients (58.9%) had comorbidity such as coronary heart disease, hypertension, diabetes, etc. 256 patients underwent surgery consisting of 162 modified mastectomies, 46 mastectomies, 38 lumpectomies, 7 lumpectomies plus lymph node dissection, 2 lymph node resection and 1 with unavailable surgery record. The cumulative 5- and 10-year overall survival was 69.9% and 40.6%, respectively. Factors affecting the prognosis were tumor size, lymph node status, pathological stage, vascular invasion and endocrine therapy by univariate analysis. The lymph node status and vascular invasion were found to be two independent prognostic factors affecting significantly the prognosis by multivariate analysis. CONCLUSION: Female breast cancer patients over 70 years of age exhibit distinctive clinical and pathological characteristics. Surgery and endocrine therapy are important to achieve good clinical outcome. Lymph node status and vascular invasion are two independent prognostic factors.