Risk for axillary lymph node involvement in early breast cancer changed at age 70

At ages younger than 70, women with breast cancer are less likely to have positive lymph node involvement with increasing age, according to the results of a retrospective study; however, at age 70 and older lymph node involvement is more likely.

Researchers examined complete data from 2,227 patients with early breast cancer from the University Hospitals Leuven, Belgium, breast cancer database. They analyzed lymph node involvement in relation to age at diagnosis. Data from a large population from the Eindhoven Cancer Registry, Netherlands, database was used to replicate and confirm study findings.

Women aged 70 or younger were less likely to have positive lymph nodes with increasing age (OR per 10-year increase=0.87), whereas women aged 70 or older were more likely to have positive lymph nodes with increasing age (OR per 10-year increase=2.93).

In women aged 70 or older, risk of lymph node involvement also increased with increasing tumor size (P=.0044), especially in smaller tumors. A similar “piecewise” effect was observed using data from the Eindhoven Cancer Registry, “but possibly with a slightly lower breakpoint,” the researchers wrote.

In an accompanying editorial, Eleftherios P. Mamounas, MD, associate professor of surgery at Northeastern Ohio Universities College of Medicine in Rootstown, discussed what these results offers from a clinical standpoint considering that many surgeons do not consider axillary dissection as necessary or beneficial in women with breast cancer aged 80 and older.

“It seems evident from the data that a subgroup of patients with a low enough risk for axillary involvement cannot be readily identified by age and that sentinel lymph node biopsy should be offered to the majority of clinically node-negative, older patients who can tolerate the procedure, irrespective of tumor size or biomarker profile,” he wrote.

Wildiers H. J Clin Oncol. 2009;doi:10.1200/JCO.2008.16.7619.