الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer in women globally, accounting for 11.6% of overall new cancer cases in females in 2018. The incidence of new cases diagnosed worldwide in 2018 was about 2.1 million and ranks as the leading cause of cancer-related death among females.Incidence rate of breast cancer among Egyptian female patients is about 48.8 per 100,000, representing 32% of all female malignancies. The geographical pattern of distribution of breast cancer across upper, middle and lower Egypt is relatively consistent. Owing to its higher prevalence in Egypt, it ranks as the second leading cause of cancer-related death overall.
Advancing age is one of the single greatest risk factors for the development of breast cancer. Globally, approximately 50% of breast carcinomas occur in women ≥ 65 years, and over 30% of breast carcinomas occur among women older than 70 years.
The purpose of the study was to determine the different breast cancer clinical and pathologic characteristics, surgical modalities and identify independent prognostic factors affecting survival among elderly Egyptian patients aged ≥65 years.
The study was conducted on one hundred and forty five (145) female patients 65 years and older with different stages of breast cancer and presented at clinical oncology department and surgical oncology unit of Alexandria Main University Hospital between January 2012 to December 2017. The patients’ clinical details, pathologic characteristics and management modalities were retrieved retrospectively from the files of female patients aged ≥65 years with different stages of the disease. All patients in the study had operable breast cancers and underwent surgery.
The data obtained were compared into three age sub-groups for statistically significant factors. These were the young-old (65-74 years), the old-old (75 – 84 years) and the oldest-old ( ≥85 years). The mean age of the patients in the study was 73 years.
With regards to the pathologic characteristics, IDC was the most common type, with Luminal subtypes being the most frequently encountered.
As pertains to the management of the disease, there was consistent, statistically significant benefit with regards to decrease in tumor size when neoadjuvant chemotherapy was administered (p=0.002) predominantly to disease stages IIB, IIIA, IIIB and IIIC. This clearly demonstrates the benefit of downstaging the disease with neoadjuvant therapy in elderly cohorts.
All patients in our study (n = 145) underwent surgical interventions. Majority had undergone MRM (82.1%) while 17.2% underwent BCS. When the type of surgery was analyzed with the stage of the disease, the results were statistically significant (p=0.009). It is important to note that 80 % of the patients in the study (n = 116) had early breast cancers that would have been amenable to breast conservation. The higher number of mastectomies may be explained by either patient choice or the reluctance of physicians to offer breast conserving surgery to the elderly.