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Wildiers H, et al. Lancet Oncol . 2007;8:1101.

Breast Cancer in Elderly (>65 Years) Recommendations of the International Society of Geriatric Oncology. Surgical recommendations are similar to those in younger patients Radiotherapy

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Wildiers H, et al. Lancet Oncol . 2007;8:1101.

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  1. Breast Cancer in Elderly (>65 Years) Recommendations of the International Society of Geriatric Oncology • Surgical recommendations are similar to those in younger patients • Radiotherapy • Considered after breast conservation therapy, taking into account patient health, functional status, and local recurrence risk • Unlikely to affect overall survival • Postmastectomy if 4+ lymph nodes or T3–4 • May be omitted if life expectancy <5 years and low risk of locoregional recurrence • Adjuvant systemic therapy • Tamoxifen and/or aromatase inhibitor (AI) appropriate for hormone-sensitive tumors • Consider toxicity profiles and slightly higher efficacy of AI • Chemotherapy choices should take into account absolute benefit, life expectancy, and tolerability • Treatment goals for metastatic disease are similar to those in younger patients Wildiers H, et al. Lancet Oncol. 2007;8:1101.

  2. Age and Molecular Subtypes Millikan RC, et al. Breast Cancer Res Treat. Epub ahead of print.

  3. Quantative ER and AgeTamoxifen-Treated Arms B-14 and B-20 P <.0001 ER (fmol/mg) Median ≤40 50–59 ≥60 Age (years)

  4. Quantative ER and Therapeutic EfficacyNSABP Studies Placebo Tamoxifen CMFT Event-Free at 12 y Postsurgery 10–49 ≥50 10–49 ≥50 ER (fmol/mg) Median

  5. Chemotherapy Toxicity by Age • 6174 patients treated in 3 chemotherapy trials • CALGB 8541: CAF at varying schedules and doses • CALGB 9344: AC at varying doses, with or without paclitaxel • CALGB 9741: Dose-dense vs standard AC-paclitaxel Muss HB, et al. J Clin Oncol. 2007;25:3699.

  6. Clinicopathologic Differences in Breast Cancer in Older Women • Histology1,2 • Increased mucinous, lobular • Decreased medullary • Favorable biologic characteristics • Endocrine responsive2 • Fewer p53 mutants2 • Lower proliferative indices2 • Fewer basal-like and more luminal A3 1. Li C, et al. Cancer Epidemiol Biomarkers Prev. 2006;15:946. 2. Diab S, et al. J Natl Cancer Inst. 2000;92:550. 3. Millikan RC, et al. Breast Cancer Res Treat. Epub ahead of print.

  7. Carcinogenesis • High ER • Differentiated • Luminal markers • Induced by HRT • Sensitive to • endocrine therapy Dontu G, et al. Trends Endocrinol Metab. 2004;15:193.

  8. Breast Cancer in African-American Women • Lower overall risk, but recent decrease in incidence not seen in African Americans • Annual percentage change (1999–2004) • Caucasians: 2.9% • African Americans: 0.5%1 • Less likely to receive adequate mammography and more likely to have higher stage at diagnosis2 • Differences in molecular subtypes • Higher prevalence of basal-like • Lower prevalence of luminal A3 • Worse survival, partly due to differences in screening, tumor characteristics, and treatment4 1. Li C, et al, Cancer Epidemiol Biomarkers Prev. 2007;16:2773. 2. Smith-Bindman R, et al. Ann Intern Med. 2006;144:541. 3.Carey LA, et al. JAMA. 2006;295:2492. 4. Curtis E, et al. Cancer. 2008;112:171-180.

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