检测乳腺癌组织内DNA倍体和ER含量的意义

本文应用流式细胞分析术检测了65例乳腺癌的细胞核 DNA 含量,同时用免疫组化 PAP 法测定肿瘤细胞中雌激素受体(Estrogen receptor ER)表达状况.结果表明二者呈负相关(P<0.01),ER(+)者异倍体占52.6%(20/38)。ER(-)者异倍体占85.2%(23/27)。提示乳腺癌的 ER 表达与 DNA 含量有一定的关系;异倍体的存在可能是 ER(+)患者对内分泌治疗不敏感的一个重要因素。     

Influence of estrogen receptor variants on the determination of ER status in human breast cancer

Determination of estrogen receptor alpha (ER) status in breast cancer is an important predictive factor for clinical response to endocrine therapy. We have recently shown that discrepancies in ER status determined by immunohistochemical assay (ER-IHA) can occur between amino-terminal (1D5) and carboxyl-terminal (AER-311) targeted ER antibodies and that those tumors which demonstrate discordance are associated with increased expression of truncated ER variant mRNAs. In this study, we have explored this observation to examine if ER variant expression can exert a direct effect on ER-IHA or whether this association is attributable to the characteristics of the antibodies. ER negative cos-1 cells were transfected with expression vectors containing wild type ER (wt-ER) and/or a frequently expressed truncated variant, ER-clone-4 variant. We found that ER-IHA performed with the same N- and C-terminal targeting ER antibodies on cos-1 cells expressing wt-ER alone demonstrated no difference in signals by western blot (P>0.1). However, co-expression of wt-ER and the truncated ER-clone-4 variant, resulted in discordant IHA results with relatively higher ER-IHA H-scores from N-terminal antibodies (P<0.03). Furthermore, re-examination of a subset of breast tumors previously studied by ER-IHA showed persistent concordance in 4/5 cases and persistent differences in 3/5 cases with a different pair of ER antibodies. We conclude that the presence of truncated ER variant proteins can interfere with the interpretation of ER status determined by IHA and that this may account for some of the inconsistencies between ER status and response to endocrine therapy.     

乳腺癌雌、孕激素受体与cerbB-2基因表达及相关分析

目的　观察乳腺癌组织中雌、孕激素受体 (ER、PR)与cerbB 2基因表达及相互关系 ,乳腺癌淋巴结转移 ,病理组织分型、临床分期与癌基因表达的关系。方法　应用免疫组织化学法对 2 10例原发性乳腺癌进行了ER、PR与cerbB 2检测。结果　ER的阳性表达率 5 9 0 5 % ,PR的阳性表达率 4 7 6 2 % ,cerbB 2的阳性表达率 33 81% ,cerbB 2的阳性表达与ER、PR的阳性表达 ,与临床分期、病理组织分型有显著相关性 (P <0 0 1) ,与腋淋巴结转移无相关性 (P >0 0 5 )。结论　ER、PR与cerbB 2在乳腺癌组织中有一定的内在联系 ,其检测结果对于临床治疗 ,辅助判断患者的预后有重要意义。     

Tobacco smoking, NAT2 acetylation genotype and breast cancer risk

The role of active and passive cigarette smoking in breast cancer etiology remains controversial. Using data from a large population-based case-control study in Poland (2386 cases, 2502 controls) conducted during 2000-2003, we examined the associations between active and passive smoking overall and for different age categories. We also evaluated differences in risk by estrogen receptor (ER) and progesterone receptor (PR) status in tumors, and the potential modification of the smoking association by N-acetyl transferase 2 (NAT2) genotype. Women ever exposed to passive smoking at home or at work had a risk of breast cancer similar to those never exposed to active or passive smoking (OR (95%CI) = 1.11 (0.85-1.46), and no trends were observed with increasing hours/day-years of passive smoking exposure. Active smoking was associated with a significant increase in risk only among women younger than 45 years of age (OR (95%CI) = 1.95 (1.38-2.76); 1.15 (0.93-1.40); 0.91 (0.77-1.09) for < 45, 45-55 and > 55 years of age, respectively; p-heterogeneity < 0.001 for < 45 vs. > 55 years) and prevailed for both ER+ and ER- tumors. The smoking association among women < 45 years was stronger for current than former smokers, and a significant trend was observed with duration of smoking (p = 0.04). NAT2 slow vs. rapid/intermediate acetylation genotype was not related to breast cancer risk (0.99 (0.87-1.13)), and did not significantly modify the smoking relationships. In conclusion, our data indicate that passive smoking is not associated with breast cancer risk; however, active smoking might be associated with an increased risk for early onset breast cancers.     

乳腺癌雌激素受体相关基因研究进展

乳腺癌是一种雌激素依赖性肿瘤,目前认为,雌激素在乳腺癌发生发展中起重要作用,而雌激素须通过雌激素受体（ER）介导发挥作用,ER包括雌激素受体α（ERα）和雌激素受体β（ERβ）,是由其基因编码的一种核转录因子,ER相关基因包括ERα基因和ERβ基因,相关研究表明ERα基因表达缺失或突变与乳腺癌预后不良有关,而ERβ基因表达与乳腺癌预后关系的相关研究却不尽一致,且基因多态性可能会影响ER在不同个体中的表达水平或功能,进而影响生物学作用的发挥。本文简要综述ER基因结构功能、基因多态性及其在乳腺癌发生发展、治疗预后和内分泌治疗中的意义。     

乳腺癌钼靶X线表现与雌激素受体、孕激素受体及人表皮生长因子受体-2的关系

目的：探讨乳腺癌的钼靶x线表现与雌激素受体（ER）、孕激素受体（PR）以及人表皮生长因子受体-2（C—erbB-2）表达之间的关系。方法：将111例经手术病理证实的乳腺癌患者钼靶X线征象中的肿块、钙化、结构扭曲、毛刺与ER、PR、C—erbB-2表达情况进行比较。结果：111例中,有肿块67例（60．36％）,有毛刺22例（19．82％）,有钙化者41例（36．94％）,有结构扭曲者21例（18．92％）。ER阳性59例（53．15％）,PR阳性46例（41．44％）,C—erbB-2阳性56例（50．45％）。肿块、钙化和结构扭曲与ER的表达无显著统计学意义;有毛刺组的ER阳性表达高于无毛刺组,有显著统计学意义。肿块、钙化、结构扭曲和毛刺均与PR的表达无显著统计学意义。有肿块组中C—erbB-2阳性表达低于无肿块组;有钙化组的C—erbB-2阳性表达高于无钙化组,都有显著统计学意义。结构扭曲和毛刺与C—erbB-2的表达没有显著统计学意义。结论：乳腺癌患者的钼靶X线表现可在某种程度上反映ER、PR、C—erbB-2的表达状况。     

ERβ、C-erbB-2及bcl-2蛋白在乳腺癌组织的表达及意义

目的：检测乳腺癌组织中雌激素受体p（ERp）、C—erbB-2和bcl-2蛋白的表达情况，并分析ERB蛋白的表达与组织学分级、C—erbB-2及bcl-2蛋白表达的关系。方法：采用免疫组化S—P法检测96例乳腺癌组织标本中ERB、C—erbB-2及bcl-2蛋白的表达情况，并作统计学分析。结果：96例乳腺癌组织标本中，ERp、C—erbB-2及bcl-2蛋白阳性表达率分别为64．6％、36．5％和51．0％；ERB蛋白的表达与组织学分级、C—erbB-2蛋白的表达呈负相关（P〈0．05），与bcl-2蛋白的表达呈正相关，与腋淋巴结状态无关（P〉0．05）。结论：ERB蛋白表达可能是乳腺癌患者预后良好的指标。     

COX inhibitors and breast cancer

There is considerable evidence to suggest that prostaglandins play an important role in the development and growth of cancer. The enzyme cyclo-oxygenase (COX) catalyses the conversion of arachidonic acid to prostaglandins. In recent years, there has been interest in a possible role for COX inhibitors in the prevention and treatment of malignancy. Cyclo-oxygenase-2 (COX-2) is overexpressed in several epithelial tumours, including breast cancer. Preclinical evidence favours an antitumour role for COX inhibitors in breast cancer. However, the epidemiological evidence for an association is conflicting. Trials are being conducted to study the use of COX inhibitors alone and in combination with other agents in the chemoprevention of breast cancer, and in the neo-adjuvant, adjuvant, and metastatic treatment settings. In evaluating the potential use of these agents particularly in cancer chemoprophylaxis, the safety profile is as important as their efficacy. Concern over the cardiovascular safety of both selective and nonselective COX-inhibitors has recently been highlighted.     

乳腺癌组织中促红细胞生成素受体表达与ER、PR及Her-2关系的研究

背景与目的:有研究发现乳腺癌肿瘤细胞表面有促红细胞生成素受体(erythropoietinreceptor,Epo-R)的表达,本研究旨在通过免疫组织化法检测乳腺癌肿瘤细胞中Epo-R的表达以及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone,PR)和人表皮生长因子受体2(human epidermal growth factor receptor 2,Her-2)的表达,探讨它们之间的关系和临床意义.方法:收集60例乳腺癌患者的标本,采用免疫组织化学法检测肿瘤组织中Epo-R的表达,同时检测肿瘤组织中的微血管密度(microvascular density,MVD),分析其与Epo-R与ER、PR和Her-2之间的关系.结果:60例肿瘤标本中47例表达Epo-R(78.3%),平均阳性细胞数(39±24)%;肿瘤组织中的MVD为25±9,与Epo-R呈正相关.Epo-R阳性患者的MVD明显高于Epo-R阴性患者(t=3.4252,P＜0.01).ER和PR的表达与Epo-R和MVD的表达均无明确的关系,而Her-2的表达与Epo-R和MVD的表达均明显相关.Epo-R的表达与临床分期、有无淋巴结转移和肿瘤大小均明显相关(均为P＜0.001);MVD与有无淋巴结转移有相关性,与分期及肿块大小无相关性.结论:乳腺癌患者高表达Epo-R,与MVD呈正相关性;Epo-R和MVD的表达与Her-2表达均有相关性,但与ER和PR的表达均无相关性.联合检测Epo-R和MVD的表达更有利于正确判断乳腺痛患者的临床病理特征及其预后.     

Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum,South India

Estrogen receptor (ER) status is an important biomarker in defining subtypes of breast cancer differing in antihormonal therapy response, risk factors and prognosis. However, little is known about association of ER status with various risk factors in the developing world. Our case–control study done in Kerala, India looked at the associations of ER status and risk factors of breast cancer. From 2002 to 2005, 1,208 cases and controls were selected at the Regional Cancer Center (RCC), Trivandrum, Kerala, India. Information was collected using a standardized questionnaire, and 3‐way analyses compared ER+/ER? cases, ER+ cases/controls and ER? cases/controls using unconditional logistic regression to calculate odds ratios and 95% confidence intervals. The proportion of ER? cases was higher (64.1%) than ER+ cases. Muslim women were more likely to have ER? breast cancer compared to Hindus (OR = 1.48, 95% CI = 1.09, 2.02), an effect limited to premenopausal group (OR = 1.87, 95% CI = 1.26, 2.77). Women with higher socioeconomic status were more likely to have ER+ breast cancer (OR = 1.48, 95% CI = 1.11, 1.98). Increasing BMI increased likelihood of ER? breast cancer in premenopausal women (p for trend < 0.001). Increasing age of marriage was positively associated with both ER+ and ER? breast cancer. Increased breastfeeding and physical activity were in general protective for both ER+ and ER? breast cancer. The findings of our study are significant in further understanding the relationship of ER status and risk factors of breast cancer in the context of the Indian subcontinent. © 2009 UICC     

乳腺增生病雌、孕激素受体表达及临床意义

目的:探讨乳腺增生病变组织中雌、孕激素受体表达情况,及其临床意义。方法:将乳腺增生病患者手术切除标本,常规福尔马林固定,石蜡包埋,采用免疫组化S-P法,测定ER、PR表达。结果ER和PR总阳性率74.36%(27/39)和87.18%(34/39),ER、PR同时阳性为66.67%(26/39)。本组不典型增生6例ER和PR阳性率均为100%,其表达强度最强,其次为腺病伴腺瘤形成,最弱为小叶增生。结论:乳腺增生病变组织中ER、PR虽然呈高表达,是三苯氧胺(TAM)治疗的适应症,但仍有25.64%的患者ER呈阴性表达,因此,用TAM治疗乳腺增生病前应检测患者的ER和PR,阳性者可用TAM治疗。     

Body weight and postmenopausal breast cancer risk defined by estrogen and progesterone receptor status among Swedish women: A prospective cohort study

Although obesity is one of the established risk factors for postmenopausal breast cancer, it is not clear whether this positive association differs across estrogen receptor (ER) and progesterone receptor (PR) status of breast tumors. We evaluated the association between body weight and ER/PR defined breast cancer risk stratified by postmenopausal hormone (PMH) use and a family history of breast cancer in the population-based Swedish Mammography Screening Cohort comprising 51,823 postmenopausal women. Relative body weight was measured by body mass index (kg/m2) based on self-reported weight and height collected in 1987 and 1997. Relative risks (RRs) were estimated by hazard ratios derived from Cox proportional hazards regression models. During an average of 8.3-year follow-up, 1,188 invasive breast cancer cases with known ER and PR status were diagnosed. When comparing to normal weight group, we observed a positive association between obesity and risk for the development of ER+ PR+ tumors (RR = 1.67, 95% CI = 1.34-2.07) and an inverse association for the development of all PR- tumors (RR = 0.68, 95% CI = 0.47-0.98). Statistically significant heterogeneity was observed in the RRs between ER+ PR+ tumors and all PR- tumors (p(heterogeneity) < 0.0001). The positive association of obesity with the development of ER+ PR+ tumors was confined to never-users of PMHs (RR = 1.90 (CI 95%:1.38-2.61)) and to those without a family history of breast cancer (RR = 1.82 (CI 95%:1.45-2.29)). Our results support the hypothesis that excess endogenous estrogen due to obesity contributes to an increased risk of ER+ PR+ postmenopausal breast cancer.     

Clinical outcome of adjuvant endocrine treatment according to PR and HER-2 status in early breast cancer.

Patients with estrogen receptor (ER)+/progesterone receptor (PR)- and/or HER-2 overexpressing breast carcinomas may derive lower benefit from endocrine treatment. We examined retrospectively data from 972 breast cancer patients who received tamoxifen (725), tamoxifen + Gn-RH analogs (127) and aromatase inhibitors (120) as adjuvant treatments. ER+/PR- versus ER+/PR+ tumours were characterised by larger size (P = 0.001), higher tumour grade (P = 0.001), higher Ki-67 expression (P = 0.001) and lower mean ER (P = 0.000) and HER-2 expression (P = 0.000). At univariate analysis, tumour grading [hazard ratio (HR) = 4.0; 95% confidence interval (CI) = 1.4-11.1; P = 0.007], nodal status (HR = 3.4; 95% CI 1.2-5.7; P = 0.000), tumour diameter (HR = 2.9; 95% CI 1.7-4.7; P = 0.000) lack of PR expression (HR = 2.1; 95% CI 1.3-3.4; P = 0.002) and HER-2 overexpression (HR = 1.9; 95% CI 1.0-3.5; P = 0.03), as well as Ki 67 expression (HR = 1.7; 95% CI 1.0-2.7; P = 0.04) were associated with shorter disease-free survival (DFS). At the multivariate analysis, nodal status (HR = 3.6; 95% CI 1.9-6.8; P = 0.0001), lack of PR expression (HR = 2.3; 95% CI 1.3-4.0; P = 0.003) and tumour diameter (HR = 2.1; 95% CI 1.1-3.8; P = 0.018) retained their prognostic significance, whereas HER-2 overexpression was associated with a trend towards shorter DFS that was of borderline statistical significance (HR = 2.0; 95 % CI 1.0-3.9; P = 0.05). Our data suggest that lack of PR expression and HER-2 overexpression are both associated with aggressive tumour features, but the prognostic information of PR status on the risk of recurrence in endocrine-treated breast cancer patients is stronger.     

Antiestrogen resistance in ER positive breast cancer cells

Summary Acquisition of the antiestrogen resistance by breast cancer cellsin vivo may result from a variety of mechanisms. The main pathway appears to involve loss of estrogen receptor (ER) expression or selection for ER negative cells among heterogenous population of tumor cells. However, clinical data suggest that, in about 30% of the cases, antiestrogen resistance arises even in the presence of estrogen receptors. Postulated mechanisms leading to the latter phenotype include selection for variant receptor forms during treatment, development of novel metabolic pathways for the drug, loss of nuclear co-factors, or activation of signal transduction pathway that cross activate ER signals. We have used anin vitro experimental system utilizing LY-2 cell line, an ER positive and antiestrogen resistant MCF-7 cell variant, to study the mechanism of antiestrogen resistance in the presence of functional ER. Result from a complementation experiment suggests that LY-2 phenotype is a recessive trait. Cloning of the genetic defect in the LY-2 cells would provide further insight for the mechanism of antiestrogen resistance in ER positive breast cancer cells.     

Dietary lignan intakes and risk of breast cancer by tumor estrogen receptor status

We examined the association of dietary lignan intake with estrogen receptor negative (ER−) and ER positive (ER+) breast cancer risk in a breast cancer case–control study. Among premenopausal women only, there was a reduced risk of ER− breast cancer for those in the highest compared to the lowest quartile of lignan intake suggesting that the observed negative association of lignans with breast cancer may be limited to ER− tumors.     

乳腺癌组织PS2与雌激素和孕激素受体的关系及预后意义

目的 :探讨PS2在乳腺癌中的表达及其与雌激素受体 (ER)、孕激素受体 (PR)关系和预后意义。方法 :采用链亲和素(LSAB)法检测 110例乳腺癌中PS2的表达。结果 :PS2在乳腺癌组织中的阳性表达率为3 9 0 9% ( 4 3 / 110 ) ,其表达与患者年龄无关 ,P >0 0 5 ;与乳腺癌瘤体大小、腋淋巴结转移呈负相关 ,P <0 0 5。在ER阳性组和阴性组 ,PS2阳性率分别为 48 5 3 % ( 3 3 / 68)和2 3 81% ( 10 / 42 ) ,P =0 0 1;在PR阳性组和阴性组 ,PS2阳性率分别为 49 15 % ( 2 9/ 5 9)和2 7 45 % ( 14 / 5 1) ,P =0 0 2 ,PS2表达与ER、PR呈正相关关系。结论 :PS2可作为判断乳腺癌预后及预测术后抗雌激素治疗效果的重要指标     

Premorbid body weight and its relations to primary tumour diameter in breast cancer patients; its dependence on estrogen and progesteron receptor status

Hormonal mechanisms have been offered as an explanation for the higher frequency of large tumours, lymph node metastases and poorer prognosis in obese breast cancer patients than in lean ones. If hormonal mechanisms are important for these relations, they should probably act more strongly in patients with hormonal receptor positive tumours than in those with negative ones. We have examined if the relations between premorbid body weight or Quetelet's index (weight/height²) and tumour diameter are modified by estrogen receptor alpha (ER) and progesteron receptor (PgR) status. The analyses were based on 1,241 women with unilateral disease treated with modified radical mastectomy living in the geografic area of Haukeland Hospital. Their body weight and height have been measured as a mean 12.5years before presentation of the disease. Body weight and Quetelet's index have been adjusted for age. The relations were studied using linear regression analyses adjusting the effect of body weight with height and mean nuclear area of the tumour cells and adjusting the effect of Quetelet's index for mean nuclear area. The main findings showed that patients with high body weight or Quetelet's index presented more often with PgR positive tumours than lean ones. Quetelet's index was also positively related to ER. These relations were present in patients older than 50 years of age (older). Patients with large tumours (>2.0cm) had significantly higher body weight and Quetelet's index than those with small ones. These differences were significantly present in older patients and in patients with PgR negative and ER negative – PgR negative tumours. Linear regression analyses confirmed that tumour diameter increases with body weight and Quetelet's index. These relations were present in both lymph node groups and in older patients. Stratification according to hormonal receptor status showed these relations to be significant in patients with ER negative, with PgR negative and those with ER negative – PgR negative tumours only. Taking age and hormonal receptor status into consideration simultaneously, both body weight and Quetelet's index were significantly related to tumour diameter in older patients with hormone receptor negative tumours. In conclusion body size was positively related to hormone receptor status and to diameter of the primary tumour. The relation to tumour diameter was present in older patients with hormone receptor negative tumours. Although hormonal mechanisms able to act on the tumour can not be excluded, mechanisms acting independent of hormonal receptors must be considered. Different mechanisms related to body fat cytokines are discussed.     

Incidence and risk factors for breast cancer subtypes in three distinct South-East Asian ethnic groups: Chinese,Malay and natives of Sarawak,Malaysia

We determined the incidences of the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) subtypes among breast cancer cases in Sarawak, Malaysia and their correlation with various risk factors in the three ethnic groups: Chinese, Malay and native. Subtype status was ascertained for 1,034 cases of female breast cancer (93% of all cases diagnosed since 2003), and the age-standardized incidence rates (ASRs) of each subtype were inferred. Case–case comparisons across subtypes were performed for reproductive risk factors. We found 48% luminal A (ER+/PR+/HER2−), 29% triple-negative (ER−/PR−/HER2−), 12% triple-positive (ER+/PR+/HER2+) and 11% HER2-overexpressing (ER−/PR−/HER2+) subtypes, with ASRs of 10.6, 6.0, 2.8 and 2.8 per 100,000, respectively. The proportions of subtypes and ASRs differed significantly by ethnic groups: HER2-positive cases were more frequent in Malays (29%; 95% CI [23;35]) than Chinese (22%; [19;26] and natives (21%; [16;26]); triple-negative cases were less frequent among Chinese (23%; [20;27]) than Malays (33%; [27;39]) and natives (37%; [31;43]). The results of the case–case comparison were in accordance with those observed in western case series. Some uncommon associations, such as between triple-negative subtype and older age at menopause (OR, 1.59; p < 0.05), were found. The triple-negative and HER2+ subtypes predominate in our region, with significant differences among ethnic groups. Our results support the idea that the risk factors for different subtypes vary markedly. Westernized populations are more likely to have factors that increase the risk for the luminal A type, while risk factors for the triple-negative type are more frequent in local populations.     

COX2 genetic variation, NSAIDs, and advanced prostate cancer risk

Collective evidence suggests that cyclooxygenase 2 (COX2) plays a role in prostate cancer risk. Cyclooxygenase 2 is the major enzyme that converts arachidonic acid to prostaglandins, which are potent mediators of inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the enzymatic activity of COX2 and long-term use of NSAIDs appears to modestly lower the risk of prostate cancer. We investigated whether common genetic variation in COX2 influences the risk of advanced prostate cancer. Nine single-nucleotide polymorphisms (SNPs) in COX2 were genotyped among 1012 men in our case-control study of advanced prostate cancer. Gene-environment interactions between COX2 polymorphisms and NSAID use were also evaluated. Information on NSAID use was obtained by questionnaire. Three SNPs demonstrated nominally statistically significant associations with prostate cancer risk, with the most compelling polymorphism (rs2745557) associated with a lower risk of disease (odds ratio (OR) GC vs GG=0.64; 95% confidence interval (CI): 0.49-0.84; P=0.002). We estimated through permutation analysis that a similarly strong result would occur by chance 2.7% of the time. Nonsteroidal anti-inflammatory drug use was associated with a lower risk of disease in comparison to no use (OR=0.67; 95% CI: 0.52-0.87). No significant statistical interaction between NSAID use and rs2745557 was observed (P=0.12). Our findings suggest that variation in COX2 is associated with prostate cancer risk.     

Risk factors for a decline in upper body function following treatment for early stage breast cancer

Purpose: To identify risk factors for a decline in upper body function following treatment for early stage breast cancer.Methods: We conducted a cross-sectional observational study of 213 women 55 years of age newly diagnosed with early stage breast cancer interviewed three to five months following their definitive surgery. Patients were classified as having impaired upper body function related to their breast cancer treatment if: 1) they reported having no difficulty in performing any of three tasks requiring upper body function (pushing or pulling large object; lifting objects weighing more than 10 pounds; and reaching or extending arms above shoulder level) prior to treatment, but reported that any of these tasks were somewhat or very difficult in the four weeks prior to interview, or 2) they reported that performing any of the three tasks requiring upper body function was somewhat difficult prior to treatment, but reported that any of these tasks were very difficult in the four weeks prior to interview.Results: In multiple logistic regression models, both the extent and type of primary tumor therapy and cardiopulmonary comorbidity were significantly associated with a decline in upper body function following breast cancer treatment.Conclusion: Given the critical importance of upper body function in maintaining independent living, clinicians should consider the functional consequences of treatment when they discuss treatment options and post-operative care with older women who have early stage breast cancer.