Background: There is discrepancy in the literature regarding the behavior of breast cancer in elderly women. For this reason we decided to study the possible clinical and biological differences of infiltrative ductal breast carcinoma between women over 70 years and those aged between 60 and 70 years.
Patients and method: The study group included 181 women with infiltrative ductal carcinomas (IDCs) who were referred from a breast clinic (BC) and a breast cancer screening campaign (BCS). 67 of them were older than 70 and 114 were between 60 and 70 years old. Estrogen receptors (ER), progesterone receptors (PR), pS2 and cathepsin D cytosolic levels were determined, as well as levels of epidermal growth factor receptor (EGFR) in cell surfaces. Likewise, size, axillary lymph node involvement, distant metastasis, histological grade, ploidy and cellular S-phase fraction were also considered as variables of the study.
Results: IDCs in women older than 70 had greater size (p<0.001), global S-phase (p = 0.009) and number of axillary lymph nodes involved (p = 0.002). Likewise, these tumors showed more frequently distant metastasis (p = 0.001) and S-phase values >14% (p = 0.093). However, when we considered only women referred from BCS, no differences in the parameters studied between women older than 70 and those aged between 60 and 70 years were observed. When only patients coming from BC were considered, women older than 70 had a greater number of axillary lymph nodes involved (p= 0.027). Patients older than 70 years from BC showed greater size (p= 0.054) and more common distant metastasis (p= 0.075) than those from BCS. Also, patients between 60 and 70 referred from BC had tumors with greater size (p <0.001), nodal involvement (p= 0.022), number of lymph nodes involved (p= 0.022) and distant metastasis (p= 0.048) than those from BCS with the same age.
Conclusions: Our results suggest that IDCs in women older than 70 years show clinical and biological features associated with a worse behaviour. However, this is only observed in women referred from BC but not in those coming from BCS. For this reason, the patient's referral site seems to be essential for the observed clinical and biological differences of breast carcinomas in the elderly.