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Age, molecular subtypes and local therapy decision-making.

Anne Kuijer1, Tari A King2

  • 1Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.

Breast (Edinburgh, Scotland)
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Tumor biology, not age, is the key factor in breast cancer treatment decisions. Intrinsic tumor biology strongly predicts outcomes for both young and older patients, guiding therapy choices.

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Area of Science:

  • Oncology
  • Breast Cancer Research
  • Surgical Oncology

Background:

  • Age and breast cancer subtype significantly influence locoregional recurrence (LRR) and survival.
  • Younger patients often have aggressive tumors, but age-related risk varies by subtype.
  • Recent advances in local and systemic therapies have improved outcomes for young women across all subtypes.

Purpose of the Study:

  • To analyze the complex interplay between patient age, breast cancer subtype, and treatment outcomes.
  • To evaluate the impact of age and subtype on locoregional recurrence and survival.
  • To determine the optimal drivers for local therapy decision-making in breast cancer.

Main Methods:

  • Review of existing literature and clinical data on breast cancer patients stratified by age and molecular subtype.
  • Comparative analysis of locoregional recurrence (LRR) and survival rates based on treatment modalities (breast conserving therapy vs. mastectomy) and patient demographics.
  • Assessment of the influence of tumor biology versus chronological age on treatment outcomes.

Main Results:

  • No significant difference in LRR or survival between breast conserving therapy (BCT) and mastectomy in young patients.
  • Triple-negative breast cancers show an increased LRR risk, independent of age or surgical approach.
  • Older women with estrogen receptor-positive breast cancer may benefit from reduced treatment intensity (e.g., avoiding axillary staging or radiation) without compromising survival.

Conclusions:

  • Intrinsic tumor biology is the primary predictor of breast cancer outcomes, superseding age.
  • Local therapy decisions should be driven by tumor biology rather than patient age.
  • Current evidence does not support contralateral prophylactic mastectomy (CPM) for improved survival.