title: Has breast cancer in the elderly remained the same over recent decades? A comparison of two groups of patients 70years or older treated for breast cancer twenty years apart.
abstract: OBJECTIVE
  Breast cancer (BC) in the elderly population is by far the most frequent malignancy in Western countries; however, little evidence is available regarding the specific management of this group. The purpose of this study was to identify how the biological and clinical characteristics of cancer have changed over the past 20years by comparing two groups of elderly patients with breast cancer operated on 20years apart. The secondary endpoint was to underline potential changes in surgical strategy over the past 20years.
  
  
  METHODS
  One group of consecutive elderly patients undergoing surgery for BC between January 1990 and December 1993 (Group A), and one group undergoing surgery between January 2008 and December 2011 (Group B) were identified and analyzed. Data regarding surgical treatment, stage, tumor grading, hormonal and HER2/neu receptors, and Ki-67 were collected and compared.
  
  
  RESULTS
  A total of 422 elderly patients underwent surgical treatment, 142 in Group A and 280 in Group B. An earlier stage at presentation was detected in Group B, T1 (57.5% B vs. 31.6% A) and N0 (64.6% B vs. 54.2% A). Surgical treatment in the first group was more extensive while conservative procedures were more frequently performed in the second group. Despite the earlier presentation, tumor grade was higher in Group B (G3 10.6% A vs. 32.1% B, p<0.05). Overexpression of Ki-67 was again more frequent in Group B (56.2% B vs. 32.5% A, p<0.05). Hormonal and HER2/neu receptor expression was comparable.
  
  
  CONCLUSIONS
  Nowadays, elderly patients with BC are more likely to present at an early stage; therefore, conservative surgery is a feasible option. Despite potential bias related to changes of pathology and immunohistochemistry examination techniques over the decades, the biological characteristics of recent patients with BC seem to be consistent with more aggressive tumors. Tailored treatment should be offered with regard to biological age, the cancer-specific profile and active life expectancy.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. Electronic address: isacmontroni@yahoo.com.
authors.forename: Isacco
authors.initials: I
authors.lastname: Montroni
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Rocchi
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.affiliation: Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ceccarelli
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ghignone
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Zattoni
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Nuvola
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Zanotti
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ugolini
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Taffurelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D055088:Early Detection of Cancer / Q000639:trends; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008197:Lymph Node Excision / Q000639:trends; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000639:trends; D060787:Neoplasm Grading / Q000639:trends; D009367:Neoplasm Staging / Q000639:trends; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen
keywords: Breast cancer; Cancer behavior; Elderly; Immunohistochemistry; Surgical treatment