Prognostic factors associated with axillary lymph node metastases for invasive breast carcinoma in patients age 70 and older

Purpose: To determine prognostic factors associated with axillary lymph node positivity in invasive female breast cancer patients 70 years of age or older. Methods: The records of 111 evaluable breast cancer patients age 70 or older that were treated at The Cleveland Clinic from 1994 to 2001 have been reviewed in their entirety. Surgical management consisted of either a modified radical mastectomy or lumpectomy with axillary lymph node dissection with or without adjuvant radiation therapy. A logistic regression analysis was performed to assess a correlation of axillary lymph node positivity to the following characteristics: tumor size, ability to palpate the lesion, lymphovascular invasion, hormone replacement, use of oral contraceptives, smoking, family history of breast cancer, location of lesion, Bloom-Richardson grade, and race. Multivariate analysis was also performed. Results: Factors that were predictors of axillary lymph node metastasis on univariate analysis were: increasing size of primary lesion (p=<0.0001), the ability to palpate the lesion on physical exam (p=0.00016), and the presence of lymphovascular invasion (p=0.0061). Family history of breast cancer in first degree relatives, race, grade, oral contraceptive use, hormone replacement, smoking, estrogen receptor status, and progesterone receptor status were not found to be statistically significant. Multivariate analysis included tumor size, lymphovascular invasion, and the ability to palpable the lesion. Lesion size (p=0.001), and tymphovascular invasion (p=0.012) were statistically significant following multivariate analysis. One patient out of 42 (2%) with tumor size 1 cm or less had axillary lymph node disease compared to 30 patients out of 68 (44%) patients with lesions larger than 1 cm. Conclusions: Our data suggests that patients with invasive breast cancer age 70 or older, may not require an axillary lymph node dissection if the primary lesion is 1cm or less in size, (hereby avoiding the associated morbidity from this procedure.