Giorgio Maria Paul Graziano and Prof Antonino Graziano*
University of Catania Medical School, Italy Aggregate professor University of Catania, Azienda Policlinico, Dpt Sciences Medical Surgery and advanced technologies, G Ingrassia, Italy
Received: 01 March, 2016; Accepted: 14 March, 2016; Published: 16 March, 2016
Prof, Antonino Graziano, Department of Sciences, Medical Surgery and Advanced Technologies, G Ingrassia via S Sofia, 86 - Cap 95125, Catania, Italy, E-mail:
Graziano GMP, Graziano PA (2016) Which Surgery in Geriatric Breast Cancer. J Surg Surgical Res 2(1): 014-017..10.17352/2455-2968.000023
© 2015 Graziano GMP et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Breast surgery; Geriatrics
Introduction: The improved living and environmental conditions have resulted in an increase in life expectancy with greater observation of breast cancer in elderly. The present study, through a retrospective analysis of our series, compares the results of treatment in two similar groups of patients under 75 (65-75) and over 75 (76-85) years of age, evaluating the efficacy and complications of loco-regional and general therapy in relationship to biological age, associated diseases, and also the influence on the results of the cultural level and lifestyle.
Materials and Methods: The criteria that we evaluated retrospective 110 patients are: age (65- 85) with mean age 75, of which 69.8% aged between 65-75 while the remaining 30.2% aged between 75-85 years; The TNM, distributed among the patients as: stage I, 5 (4.5%), stage II No 56 (50.9%), stage III No 30 (27.3%) stage IV No. 19 (17.2 %). Associated diseases. Considered in the two groups were BPCO hypertension, cerebrovascular disease, BMI pathological.
Results: Surgical treatment was mastectomy, QUART, lumpectomy. And search for the sentinel node. The evaluation excluded patients treated on tumorectomy and mastectomy. Complications, shown in Tables 1, have been modest. Perioperative mortality was absent.
Discussion: In geriatric patients with breast cancer it is significantly detected as our series. This finding raises the question of what therapeutic strategy should be implemented to overcome the line of thought that suggests a limited therapeutic treatment, and therefore presumably inadequate The TNM staging effective to determine the true extent of the disease is essential to avoid a therapeutic treatment is not appropriate, without unnecessary unless a truly effective treatment for elderly patients
Conclusions: In the treatment of patients with geriatric breast cancer, TNM cancer criteria were adopted without removing other as ASA ‘Karnosky Index. This therapeutic approach, beyond old age, considered almost a marginal factor, obtained satisfactory results with a lengthening of life expectancy
The improving of socio-economic and environmental conditions have produced an increase in life expectancy, with greater observation of breast cancer in elderly. The actual data confirm this trend by estimating (Foncam) 1/400 in the detection of breast cancers in adults (over 70 years). This is related, in this decade of life, with varying the hormonal immune-modulation system, and with a relative decrease in vitamin consumption. The short comings are still present in the therapeutic age group (65-85 years) with favors a partial staging [1,2], of the disease to which follows a relatively inadequate treatment, with a reduction of survival. A more aggressive therapeutic approach, oncological more radical in relation to the extension of life expectancy, even when there are no opinions unique [3,4], has led us to develop this study through a retrospective analysis of our experience, considering the ‘effectiveness of therapy in two group of patients under 75 years of life and over 75.
Materials and Methods
Patients with breast cancer observed from 2000 to 2010 at the III clinical surgery (2000-04) and in the Department of Surgery Specialist II of the Policlinico Catania were 110. The criteria that we evaluated retrospectively the entire together they were: age (65- 85) with mean age 75, of which 69.8% aged between 65-74 while the remaining 30.2% aged between 75-85 years; The TNM, finding stage I in 5 cases (4.5%), stage II No 56 cases (50.9%), stage III in 30 cases (27.3%), stage IV in 19 (17 , 2%). The tumor morphology observed with its variety histological was: infiltrating ductal carcinoma in 88 patients (80°%), adenocarcinoma in 11 patients (10%), mucinous adenocarcinoma in 6 patients (5%), disease, Paget in 5 patients . (5%). surgical treatment was assessed both in relation to the TNM that the clinical condition of the patient. All patients forming part Of this retrospective analysis were subjected to the processing, as shown in the Tables 1a,b,c,d. To assess elderly patients the impact of treatment on-site regional and general approach, we divided the patients into two groups and, in particular, were compared two homogeneous groups of patients where treatment side-regional type was the quart with the study sentinel node (Figures 1-3).
- Herbsman H, Feldman J, Seldera J, Gardner B, Alfonso AE (1981) Survival following breast cancer surgery in the elderly. Cancer 14: 2358-2363 .
- Hunt KE, Fry DE, Bland KI (1980) Breast carcinoma in the elderly patient an assessment of operative risk morbidity and mortality. Am J Surg 140: 339-342 .
- (2014) Linee guida AIOM XVI Congresso Nazionale a Roma dal 24 al.
- Gentile A, Greco L, Chiumarulo C (2003) carcinoma mammario in età avanzata. Ann Ital Chir LXXIV, 3: 275-278 .
- Isik A, Peker K, Firat D, Yilmaz B, Sayar I, et al. (2014) Importance of metastatic lymph node ratio in non-metastatic, lymph node-invaded colon cancer: a clinical trial. Med Sci Monit 20: 1369-1375 .
- Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C (2014) Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ 11: 348: 226.
- Bordeleau L, Panchal S, Goodwin P (2010) Prognosis of BRCA-associated breast cancer: a summary of evidence. Breast Cancer Res Treat 119: 13-24 .
- Kirova YM Savignoni A, Sigal-Zafrani B, de La Rochefordiere A, Salmon RJ, et al. (2010) Is the breast-conserving treatment with radiotherapy appropriate in BRCA1/2 mutation carriers? Long-term results and review of the literature. Breast Cancer Res Treat 120: 119-126 .
- Pierce LJ, Strawderman M, Narod SA, Oliviotto I, Eisen A, et al. (2000) Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol 18: 3360-3369 .
- Host H, Lund E (1986) Ages as a prognostic factor in the breast cancer cancer 57: 2217-2221 .
- Møller P, Borg A, Evans DG, Haites N, Reis MM, et al. (2002) Survival in prospectively ascertained familial breast cancer: analysis of a series stratified by tumour characteristics, BRCA mutations and oophorectomy. Int J Cancer 101: 555-559 .
- Svastics E, sulyokz, beszyak I (1989) Treatment of breast cancer in women older than 70 years. J Surg Oncol 41: 19-21 .
- Ingle JN, Twito DI, Schaid DJ, Cullinan SA, Krook JE, et al. (1991) Combination hormonal therapy with tamoxifen plus fluoxymesterone vs tamoxifen alone in postmenopausal women with metastatic breast cancer. An updated analysis. Cancer 67: 886-891 .
- Heemskerk-Gerritsen BA, Brekelmans CT, Menke-Pluymers MB, van Geel AN, Tilanus-Linthorst MM, et al. (2007) Prophylactic mastectomy in BRCA1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg Oncol 14: 3335-3344 .
- Kessler HJ, Seton JZ (1978) The treatment of operable breast cancer in the elderly female. Am J Surg 135: 664-666 .
- Graziano A (1992) ruolo della linfectomia di I livello nel ca mammario Atti SIC Roma I: 483-487.
- Trainer AH, Lewis CR, Tucker K, Meiser B, Friedlander M, et al. (2010) The role of BRCA mutation testing in determining breast cancer therapy. Nat Rev Clin Oncol 7: 708-717 .
- Graziano A (2012) Examination axillary sentinel for Ultrasound in breast cancer 13 - 15 September, 2012 - Palma de Mallorca, Spain USP NESA Innovation Days.
- Atchley DP, Albarracin CT, Lopez A, Valero V, Amos CI, et al. (2008) Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer. J Clin Oncol 26: 4282-4288 .
- Turner NC, Filho JS (2006) Basal-like breast cancer and the BRCA1 phenotype. Oncogene 25: 5846-5853 .
- Boughey JC, Khakpour N, Meric-Bernstam F, Ross MI, Kuerer HM, et al. (2006) Selective use of sentinel lymph node surgery during prophylactic mastectomy. Cancer 107: 1440-1447 .
- Greenfield S, Bianco DM, Elashoff RM, Ganz PA (1987) Patterns of care related to age of breast patients. Jama 257: 2766-2770 .