Axillary lymph node involvement in women with breast cancer: does it depend on age?

Introduction: Despite the reduced aggressiveness of breast cancer with older age, elderly patients are diagnosed with larger and more advanced tumors compared with younger patients. We studied the specific relationship between lymph node (LN) involvement and age. Patients and Methods: Data were analyzed on 12,152 consecutive breast cancer patients who were operated on between 1995 and 2006 in a single institution. Cubic spline logistic models were used. Results: LN involvement was present in 5409 patients (44.5%). Median age was 52 years; median tumor diameter was 1.7 cm; 83.4% had positive estrogen receptors; and 15.3% had human epidermal growth factor receptor (HER) 2/neu overexpression. At the univariate analysis, the probability of LN involvement decreased with increasing age up to approximately 65 years, but it increased thereafter. However, when investigating the relationship in pT strata, after adjusting for other prognostic factors, we observed no increase of LN involvement probability in elderly patients. Conclusion: Increasing risk of LN involvement in the elderly can be explained by delayed diagnosis in this age group. Lack of systematic screening programs for this subpopulation and tendency of the elderly to wait longer before consulting a physician might be blamed. Aging per se does not increase the risk of LN involvement.