Influence of age on the metastatic behavior of breast carcinoma

The effects of aging on the biologic behavior of malignant neoplasms are poorly understood. To examine the question of a possible age effect on the metastatic behavior of tumors, we reviewed the clinical histories, autopsy protocols, and histologic slides of 187 patients with metastatic breast carcinoma who were subjected to complete autopsy at The Johns Hopkins Hospital. Patients were categorized in four groups according to the age of onset of breast carcinoma: group I had 12 young patients (less than 40 years old); group II had 41 patients, 40 to 46 years old, considered to be premenopausal; group II had 89 patients, 47 to 60 years old, considered to be early postmenopausal; and group IV had 45 patients over 60 years old, considered to be late postmenopausal. Group II patients survived about 50% longer than group III or IV patients (p less than 0.05), and groups I, II, and III patients had significantly greater numbers of metastases than group IV patients (p less than 0.05). There was a progressive decline in the frequencies of metastases in several locations as a function of age, such that group I and II patients had significantly more frequent metastases to the central nervous system (p less than 0.05), endocrine organs (p less than 0.01), ovary (p less than 0.05), pancreas (p less than 0.01), and gastrointestinal tract (p less than 0.05) than patients in group III or IV. These differences in number and distribution of metastases were not explainable on the basis of survival, therapy, or initial stage of disease. The results suggest that the process of aging may influence the metastatic behavior of breast carcinoma; hormonal and metabolic factors may be implicated.