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Breast cancers behave differently before and
after the age of 70…Do
the immune defense mechanisms play a role?
Berlin, Germany: Researchers in Belgium have discovered that increasing age
affects the way breast cancer behaves.
As women approach the age of 70, they become less likely to be diagnosed
with aggressive tumours that have spread to
the lymph nodes. But after 70, the cancer is
increasingly likely to spread, particularly
if the tumours are small.
Until now, there has been conflicting evidence on aging and
lymph node involvement and this study is the
first to show clearly how the link between
the two changes before and after the age of
70.
Professor Hans Wildiers told the 6th European Breast Cancer
Conference (EBCC-6) in Berlin today
(Friday), that he suspects that women older
than 70 have decreased immune defence
mechanisms, which are less able to deal with
tumours that are likely to metastasise to
other sites in the body.
“The effect of age of lymph node positivity is not
straightforward. There seems to be a
different effect between women aged up to 70
years and women older than 70. For the
younger group of women, age appears to have
a negative effect on lymph node status – the
older they become, the less likely the
cancer is to have spread to the lymph nodes.
"For the older group of women (aged over 70), age appears to
influence lymph node status in the opposite
way – the older they become, the more likely
they are to have cancer cells in the lymph
nodes if the tumour is small,” said Prof
Wildiers, who is adjunct head of clinic in
the department of general medical oncology
at the Multidisciplinary Breast Centre,
University Hospitals Leuven, Belgium.
“There is an interaction between age and tumour size,
suggesting that, up to the age of 70, age
mainly has a positive effect on lymph node
status for older women with small tumours.
"A likely explanation is that breast tumours metastasise less
frequently to lymph nodes with increasing
age due to the decreased biological
aggressiveness in these tumours. On the
other hand, over the age of 70, if the
tumours have the potential to metastasise to
lymph nodes, this occurs more rapidly in
smaller tumours and this might be related to
decreased immune defence mechanisms in
elderly patients.”
Prof Wildiers and his colleagues investigated 2,227 women who
had been treated for breast cancer between
2000 and 2006 at the University Hospitals
Leuven. Then they compared the results with
a separate database of over 11,000 breast
cancer patients on the Eindhoven Cancer
Registry.
They found that for women aged 70 or younger, increasing age
was associated with a decreased prevalence
of cancer spreading to the lymph nodes. The
women’s risk of having positive lymph nodes
decreased by 13% for every decade they aged,
up to age 70.
Once aged 70 and over, the odds of lymph node involvement
doubled with every 10-year increase in age
for women who had tumours that were no
bigger than 15mm across. If the tumours were
larger than 42-43 mm, then risk of lymph
node involvement continued to decrease.
Prof Wildiers said: “We know that the elderly have depressed
immune defences, and, therefore, it is
possible that these decreased defences are
unable to prevent invasion of the lymph
nodes by metastases in a subset of breast
tumours in elderly women.
"Although breast cancer survival in older women appears to be
similar to survival in the general
population irrespective of disease status,
it might well be that there is a balance in
the elderly between, on the one hand, a less
aggressive type of tumour, and, on the other
hand, their decreased immunological defences.”
He said the findings supported the idea that there are two
types of tumour in elderly women: ones that
are slow-growing and don’t invade the lymph
nodes even if the tumours are larger, and
ones that are aggressive and metastasise
very early to the lymph nodes.
Women with slow-growing tumours might benefit from less
aggressive treatment, while the smaller
tumours in the women aged over 70 might need
to be treated more aggressively.
“Further research now needs to be conducted into the role the
immune system plays in lymph node invasion,”
he concluded.
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