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Annals of Oncology Advance Access originally published online on March 9, 2007
Annals of Oncology 2007 18(6):991-996; doi:10.1093/annonc/mdm063
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© 2007 European Society for Medical Oncology

breast cancer

Breast cancer in elderly women: a different reality? Results from the NORA study

G Mustacchi1,*, ME Cazzaniga2, P Pronzato3, A De Matteis4, F Di Costanzo5, I Floriani6 On behalf of the NORA Study Group

1 Medical Oncology, University of Trieste, Trieste
2 Medical Oncology, Treviglio Hospital, Treviglio
3 Medical Oncology, La Spezia Hospital, La Spezia
4 Medical Oncology, Pascale Institute, Napoli
5 Medical Oncology, Careggi Hospital, Firenze
6 Oncology Department, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy

* Correspondence to: Prof. G. Mustacchi, Medical Oncology, University of Trieste, Via Pietà 19, 34100 Trieste, Italy. Tel: +39-040-3992232; Fax: +39-040-7606111; E-mail: g.mustacchi{at}fmc.units.it

Background: The incidence of breast cancer increases with age, and the disease affects many older women; however, attitudes about prevention and treatment of breast cancer vary based on the patient's age. Older women have less access to clinical trials and fewer opportunities for treatment with innovative therapies. The National Oncological Research observatory on Adjuvant therapy in breast cancer (NORA) study was a cohort study designed to obtain information about adjuvant strategies for treatment of breast cancer after surgery, patterns of recurrence, and possible correlations between cancer-related events and biological factors.

Patients and methods: This report describes patient characteristics, disease status, and local and systemic adjuvant treatments in a population of breast cancer patients aged ≥65 years. The NORA study consecutively enrolled >3500 patients from 2000 through 2002 at 77 Italian hospitals; of these, 1085 were aged ≥65 years. Data on patient characteristics, cancer presentation, and treatments were analyzed to identify possible relationships between these factors and age.

Results: The findings indicate that age is significantly related to later diagnosis and different patterns of treatment. Choice of adjuvant systemic treatment was primarily related to hormone receptor status and tumor stage but was strongly influenced by the patient's age; there was a proportional relationship between endocrine treatment and increasing age. Cyclophosphamide, methotrexate, and 5-fluorouracil as well as anthracyclines were widely used, but the use of taxanes was limited to a very small percentage of patients.

Conclusions: The findings of the NORA study may help to change attitudes that currently exclude a significant proportion of breast cancer patients from secondary prevention policies, more active treatment strategies, and clinical research trials based on age.

Key words: adjuvant therapy, breast cancer, elderly

Received for publication October 28, 2006. Revision received January 22, 2007. Accepted for publication January 23, 2007.


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