Breast Cancer Older Women

Dr Hughes in internationally recognized as an expert in breast cancer in older women, having run one of the largest breast cancer trials in this population.  This trial identified that women age 70 and over  with small estrogen receptor positive breast cancer received little benefit from radiation therapy.

This slide set was presented by Dr Hughes at the Miami Breast Conference, 2012:

Slideset-BreastCancer in Older Women

 

His published work on this topic is listed here.  Those citations that are underlined can be ‘Clicked’ to show the entire article.

Breast Cancer In Older Women

Hughes KS, Schnaper L, Berry D, Cirrincione C, McCormick B, Smith T, Shank B, Smith BL, Shapiro C, Muss H, Winer E, Wood W, Sugarbaker D, Henderson C, Norton L: A randomized comparison of lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early stage breast cancer. New England Journal of Medicine 2004;351: 971-977.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs Aging. 2008;25(1):47-8.

Inouye P, Schnaper, LA, Buyske J, Shank BM, Shapiro CL, Berry DA, Wilder KLM, Hughes KS: Carcinoma of the Breast in the Geriatric Population. Surgical Rounds 1997;4 (3): 146-20.

Schnaper LA, Hughes KS: Special Considerations When Treating Breast Cancer in the Elderly.  Breast Disease – An International Journal 2001;12: 83-93.

Schnaper LA, M.D.Hughes KS, M.D., for the Cancer and Leukemia Group B, Radiation Therapy, Oncology Group, and Eastern Cooperative Oncology Group: Can Radiation be Omitted Following Breast Conserving Surgery in Women Over 70 With Early Stage Breast Cancer? The American Journal of Oncology Review. In Press.  2004

Howard-McNatt M, Hughes KS, Schnaper LA, Jones JL, Gadd MA, Smith BL: Breast Cancer Treatment in Older Women. Surgical Clin NA, 2005;14(1): 85-102, vi. Review.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs and Aging 2008;25:47-48.

Carlson RW, Moench S, Hurria A, Balducci L, Burstein HJ, Goldstein LJ, Gradishar WJ, Hughes KS, Jahanzeb M, Lichtman SM, Marks LB, McClure JS, McCormick B, Nabell LM, Pierce LJ, Smith ML, Topham NS, Traina TA, Ward JH, Winer EP.  NCCN Task Force Report: breast cancer in the older woman.  The Journal of the National Comprehensive Cancer Network. 2008;6 Suppl 4:S1-S25.  Quiz S26-S27.

Kimmick G, Hughes KS, Muss H: Breast Cancer in Older Women.  In: Harris J, Lippman M, Morrow M, Osborne C (eds.) Diseases of the Breast, Lippincott Williams and Wilkins. 2004 and 2009

9343Page

Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer:  Long-Term Follow-Up of CALGB 9343

Kevin S. Hughes, Lauren A. Schnaper, Jennifer R. Bellon, Constance T. Cirrincione, Donald A. Berry,

Beryl McCormick, Hyman B. Muss, Barbara L. Smith, Clifford A. Hudis, Eric P. Winer, and William C. Wood

A B S T R A C T

Purpose

To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age _ 70 years with early-stage breast cancer.

Patients and Methods

Between July 1994 and February 1999, 636 women (age _70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS).

Results

Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively.

Conclusion

With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age _ 70 years with ER-positive early-stage breast cancer.

J Clin Oncol 31:2382-2387. © 2013 by American Society of Clinical Oncology

HughesSchnaper2013_9343_JCO.2012.45.2615.full

Hughes KS, Schnaper L, Berry D, Cirrincione C, McCormick B, Smith T, Shank B, Smith BL, Shapiro C, Muss H, Winer E, Wood W, Sugarbaker D, Henderson C, Norton L: A randomized comparison of lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early stage breast cancer.  New England Journal of Medicine 2004;351: 971-977.

Hughes KSWhy do we believe that breast cancer in the elderly is the same as breast cancer in young women?  Drugs Aging. 2008;25(1):47-8.

Inouye P, Schnaper, LA, Buyske J, Shank BM, Shapiro CL, Berry DA, Wilder KLM, Hughes KS:  Carcinoma of the breast in the geriatric population.  Surgical Rounds 1997;4 (3): 146-20.

Schnaper LA, Hughes KS: Special considerations when treating breast cancer in the elderly.  Breast Disease – An International Journal 2001;12: 83-93.

Schnaper LA, M.D.Hughes KS, M.D., for the Cancer and Leukemia Group B, Radiation Therapy, Oncology Group, and Eastern Cooperative Oncology Group: Can radiation be omitted following breast conserving surgery in women over 70 with early stage breast cancer? The American Journal of Oncology Review. In Press.  2004

Howard-McNatt M, Hughes KS, Schnaper LA, Jones JL, Gadd MA, Smith BL: Breast cancer treatment in older women. Surgical Clin NA, 2005;14(1): 85-102, vi. Review.

Hughes KS. Why do we believe that breast cancer in the elderly is the same as breast cancer in young women?  Drugs and Aging 2008;25:47-48.

Carlson RW, Moench S, Hurria A, Balducci L, Burstein HJ, Goldstein LJ,

Gradishar WJ, Hughes KS, Jahanzeb M, Lichtman SM, Marks LB, McClure JS, McCormick B, Nabell LM, Pierce LJ, Smith ML, Topham NS, Traina TA, Ward JH, Winer EP.  NCCN Task Force Report: breast cancer in the older woman.  The Journal of the National Comprehensive Cancer Network. 2008;6 Suppl 4:S1-S25.  Quiz S26-S27.

Kimmick G, Hughes KS, Muss H: Breast Cancer in Older Women.  In: Harris J, Lippman M, Morrow M, Osborne C (eds.) Diseases of the Breast, Lippincott Williams and Wilkins. 2004 and 2009

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