title: Clinically cN0 breast cancer in elderly: what surgery?
abstract: BACKGROUND
  Breast carcinoma is the most common cancer in women worldwide. The incidence increases with age. Elderly patients have more advanced disease than younger ones, but they have a more favorable biologic tumor profile overall. The management of breast cancer in elderly is controversial. We report our experience with breast cancer in older than 65 years in the last 5 years, in order to assess how many axillary dissection may have been avoided, according to disease free survival (DFS) and overall survival (OS).
  
  
  METHODS
  We enrolled in our retrospective study all over 65 year old patients referred to the Breast Unit of our Department of Clinical Medicine and Surgery at the University of Naples Federico II from January 2009 to December 2013. The end points were: evaluation of the rate of axillary treatment avoidable, DFS and OS.
  
  
  RESULTS
  We recruited 133 over 65 year old patients. Axillary lymph node was not palpable in 109 patients. The rate of involved axillae in patients without palpable nodes treated was 11.8%. The mean follow up was 35.7 months. At the time of data collection 3 patients had developed IBTR. No one had axillary recurrence, independently from the chosen treatment. 2 patients died for causes different from breast cancer.
  
  
  CONCLUSIONS
  DFS and OS are the same both in patients with treated and no treated axilla. Even if evidences about the treatment of breast cancer in elderly are still controversial, each patient deserves a multidisciplinary approach to discuss the best treatment option.
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: glimite@unina.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Limite
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: rosadimicco@alice.it.
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Micco
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: vivianasollazzo@gmail.it.
authors.forename: Viviana
authors.initials: V
authors.lastname: Sollazzo
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: emanuelaexpo@hotmail.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: mariacervotti@alice.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Cervotti
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: rita.compagna@libero.it.
authors.forename: Rita
authors.initials: R
authors.lastname: Compagna
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: dewerra@unina.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Werra
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: bramato@unina.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Italy. Electronic address: p.forestieri@unina.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010808:Physical Examination; D012189:Retrospective Studies
keywords: Breast cancer; Elderly; Surgical treatment