In the period from the 1st January 2015 to the 30th June 2015,
67 women aged 70 years or older with a newly diagnosed breast cancer were identified.
The mean age of patients was 77.1 years (range 70 – 91 years).
Of these patients,
28 were asymptomatic (41.8%,
mean age 75.3 years),
while 39 had symptoms (58.2%,
mean age 78.3 years): 33 were affected by a palpable mass,
1 by an ulcerated lump,
3 by a sore nodule and 2 by a pathologic nipple discharge Fig. 2.
The more frequent histological diagnosis was invasive ductal carcinoma (48/67,
followed by invasive lobular carcinoma (9/67,
in situ ductal carcinoma (3/67,
4.5%) and other,
in asymptomatic patients,
the histological diagnosis was: in 19 cases (67.9%) invasive ductal carcinoma,
in 5 cases (17.9%) invasive lobular carcinoma,
in 1 case (3.6%) mucinous carcinoma,
in 3 cases (10.7%) in situ ductal carcinoma.
In symptomatic patients,
the histological diagnosis was: in 29 cases (74.4%) invasive ductal carcinoma,
in 4 cases (10.3%) invasive lobular carcinoma,
in 1 case ductal-lobular invasive carcinoma (2.6%),
in 1 case (2.6%) mucinous carcinoma,
in 1 case intraductal papillary carcinoma (2.6%),
in 2 cases (5.1%) papillary carcinoma,
in 1 case apocrinous invasive carcinoma (2.6%).
The distribution of histological subtypes was not significantly different between asymptomatic and symptomatic patients (p=0.0791) Fig. 3.
The disease was unifocal in 46/67 patients (68.7%),
multifocal in 16/67 patients (23.9%) and multicentric in 5/67 patients (7.5%); cases of bilateral disease were not found.
Among asymptomatic patients,
19/28 were affected by unifocal disease (67.9%),
7/28 by multifocal disease (25%) and 2/28 by multicentric disease (7.1%).
Among symptomatic patients,
27/39 were affected by unifocal disease (69.2%),
9/39 by multifocal disease (23.1%) and 3 by multicentric disease (7.7%).
The distribution of unifocal,
multifocal and multicentric disease was not statistically different between asymptomatic and symptomatic patients (p=0.1991) Fig. 4.
The case of a patient 83 years old with a palpable lump (multifocal disease with node metastasis,
IDC G3 pT2 N2a) is shown in Fig. 6 Fig. 7.
The mean diameter of breast cancers assessed with mammography was 20.3 mm.
In symptomatic women it was 23.5 mm and in asymptomatic patients it was 16.3 mm (difference: 7.2 mm; 95% CI of the difference: 2.5 mm / 12 mm; p=0.0036).
The mean diameter of breast cancers assessed with ultrasound was 19.8 mm.
In symptomatic women it was 22.8 mm and in asymptomatic patients it was 14.9 mm (difference: 7.9 mm; 95% CI of the difference: 3.5 mm / 12.4 mm; p=0.0007) Fig. 5.
With respect to mammography,
it was not performed in 6 patients with symptoms and in 3 asymptomatic women,
due to the clinical status.
It was negative (false negative result) in 4 patients with symptoms and in 1 asymptomatic woman.
The most frequent presentation pattern of breast cancer was the presence of a mass,
both in symptomatic (26/29 – 89.6%) and in asymptomatic (17/24 – 70.8%) patients.
Parenchymal distortions were present in 3 symptomatic patients (3/29 – 10.3%) and in 2 asymptomatic patients (2/24 – 8.3%).
In patients without symptoms 3 cases of breast cancer were identified as a microcalcifications cluster (3/24 – 12.5%),
while 2 cases were identified as density asymmetries (2/24 – 8.3%); none of the cases of breast cancer in symptomatic patients was identified because of microcalcifications cluster or density asymmetries.
With respect to ultrasound,
it was not available in 1 patient with symptoms and in 4 asymptomatic women.
In 61 cases a mass was found (38/38 -100% - cases of patients with symptoms and 23/24 – 95.8% – cases in patients without symptoms),
in 1 (asymptomatic) patient an ultrasound inhomogeneity.