Biology Of Breast Cancer In Older Women

As per a recent research, conducted by Binafsha Syed and her fellow associates at the University of Nottingham, the biological characteristics of breast cancer change with advancement in age. As part of the study, about 1750 old women who were 70 years or older, and were suffering from early operable breast cancer were managed in a dedicated clinic to understand the distinct biology of cancer in older women.

It was found that cancer tends to become less aggressive with advancement in age and therefore treatment choices too should be different in older women. Older women, owing to their frail health might not even be able to tolerate certain specific kinds of treatment.

Some old women who have small tumors are made to undergo certain procedures, for instance, axillary node dissection, which can be avoided as they are not likely to benefit from additional staging information that this procedure will provide.

The primary characteristics of breast cancer in older women are listed below:

• Older women tend to have a unique biological kind of breast cancer, known as low estrogen receptor luminal. Women with this type of breast cancer have shown to have a better survival rate.
• There is high expression of PgR, estrogen receptor (ER), Muc1, Bcl2, BRCA1 and 2, luminal cytokeratins, E-cadherin, HER3, HER4, MDM2 and 4. There is low expression of human epidermal growth factor receptor (HER)-2, p53, Ki67, EGFR and CK17.
• The study of unsupervised partitional clustering depicted that six biological clusters were formed in breast cancer patients. Out of these, five were common in the younger patients. The low ER luminal cluster was distinct in the older women and showed better cancer-survival rate.
• Old women are also likely to have tumors in both the breasts since the factors that contribute to the growth of tumor in one breast are also likely to be present in the other breast.
• In most cases, the tumors in older women are indolent, but aggressive breast cancer cannot be completely ruled out.

Treatment considerations for Cancer in Older Women

In older women, if the overall health is good, doctors advise removal of the tumor through an operation. In certain specific cases, if the health of the patient is frail, doctors might omit radiation. Chemotherapy is often omitted in older women. In a majority of cases, where the women have slow growing tumors, the omission of radiation and chemotherapy might not reduce the overall life span. As per a study, older women who suffer from hormone receptor positive breast cancer and who are either unwilling or are not in a condition to undergo surgery, can also be treated successfully by using the aromatase inhibitor, known as Femara.

Older women, in their seventies, who are otherwise healthy, but are suffering from breast cancer that is likely to metastasize, can benefit by the use of radiation and chemotherapy, similar to what is prescribed to a middle aged cancer patient.