Serum Tumor Markers in Stage I-II Breast Cancer.

The prognosis of breast cancer is strongly influenced by the stage of the disease; therefore, it is essential that breast cancer lesions be diagnosed at the earliest stages. There is an urgent need to identify different biomarkers with a high accuracy for the early detection of this cancer to facilitate clinical management of the disease. A wide number of substances named serum tumor markers can be detected in the serum of patients with breast cancer, including tumor-associated proteins, cytokines, stimulating or inhibiting factors, autoantibodies to antigen tumor-associated substances and miRNAs. Despite ASCO and NACB recommendations, the routine use of breast cancer tumor markers by a significant proportion of oncologists is common, particularly after primary treatment of early tumors. The new promising circulating markers are HER2/neu, Trx 1, CSF1, autoantibodies against these tumor-associated antigens, and miRNAs, which are non-coding RNA molecules that regulate the translation of mRNA and control a number of biological processes, including oncogenic cells proliferation. The expression of single miRNA results in a miRNA signature, and is considered a potential biomarker for early breast cancer. However, additional studies are needed to identify its real usefulness.

Adjuvant Treatment of Early Breast Cancer in the Elderly.

Breast cancer is common in the elderly, as more than 50% of these tumors are diagnosed in patients aged 65 years or older. Elderly women may also delay reporting or underreport to their physician suspicious symptoms and lesions, so that breast cancer is more likely to be diagnosed at a more advanced stage, with putatively inferior outcomes. Adjuvant hormonal therapy has clear benefits for all women with hormone receptor-positive early breast cancer, despite the fact that it is still under-prescribed in elderly women, but the benefits of tamoxifen are more evident than that observed in younger patients. Aromatase inhibitors significantly prolong disease-free survival, reducing the risk of metastases and contralateral cancer compared with tamoxifen, and these benefits are greater in women aged ≥65 years. However, in case of a history of pathological fractures, arthritis or chronic musculoskeletal pain syndromes, tamoxifen still represents the preferred adjuvant option. In patients with a high risk of recurrence with hormonal therapy alone, the cardiac toxicity of nonanthracycline regimens should be taken into account. Trastuzumab-based therapy should be offered to most patients with HER2-overexpressing tumors. Older patients have an increased risk of disease recurrence and cancer-related mortality, because they are usually undertreated due to their age and longevity. Thus, a multidisciplinary geriatric approach is required, but the optimal management of these patients is still not well defined.