Abstract P1-01-08: An impending avalanche-breast cancer among women ≥ 90 years of age
Authors: Ozerdem U , Tavassoli FA 
Published: May 2016

INTRODUCTION: Pubmed database shows no study on pathological features of breast carcinoma in extremely old women (≥90 years). The data post 1980s is limited due to the definition of such age limit as "older than 75". This study redefines age extreme in breast pathology to better correlate with current patient demographics, and provides characteristics of breast cancer in this population. Little information exists about the breast cancer in extremely old women. This investigation elucidates the growing number of breast cancer diagnoses in extremely old women (≥90 years) in a single institution in 2000s.

MATERIALS AND METHODS: The database of Yale University Department of Pathology was searched for the terms: "breast carcinoma," "age ≥90" for the past 15 years. Clinicopathologic features of the cases that fit the criteria were studied.

RESULTS: A total of 135 patients (134 female; 1 male) aged ≥90 years were identified with a diagnosis of infiltrating carcinoma. A surge in breast cancer diagnoses among elderly patients was noted in 2000s compared to the earlier decade. Only 10 cases were diagnosed between 1990 and 1999 (one case/year) compared to 125 cases diagnosed between 2000 and 2015 (8.3 cases/year). Of these 135 patients, 117 had infiltrating ductal carcinoma (IDC); 16 had infiltrating lobular carcinoma (ILC),1 had pure squamous cell carcinoma. One patient had IDC and ILC ipsilaterally, while another had bilateral IDC. The median age was 92 (range: 90-107), median tumor size was 2.0 cm (range: 0.2-13.0), and the median modified Bloom & Richardson score was 6 (range: 3-9). Among the 117 IDCs, 11 had mucinous, 6 had apocrine, 1 had medullary, 1 had cribriform differentiation. Ductal intraepithelial neoplasia (DCIS) was present in 46% of the cases, while lobular intraepithelial neoplasia (LCIS) was identified in 8% of the cases.

CONCLUSIONS: Our data shows an increasing number of breast carcinomas diagnosed among patients ≥90 years of age with a morphological distribution similar to other age groups. This increased frequency is particularly notable in the last 15 years compared to 1990s. While increased life expectancy is a factor, better delivery of screening to elderly patients and patient awareness are important additional contributors to this increase. Extremely old women particularly those in good health may potentially benefit from breast cancer screening. As the number of substantially older patients with breast cancer increases, we have to be prepared to manage the disease in this population. Further studies are warranted to elucidate the frequency of breast cancer in extremely old women and the optimal management that would probably have to be individualized to the patients' health status.

Citation Format: Ozerdem U, Tavassoli FA. An impending avalanche-breast cancer among women ≥ 90 years of age. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-01-08.