Breast cancer is the second leading cause of cancer-related deaths in women. Over three-fourths of all breast cancer cases are considered estrogen receptor positive (ER+). Significantly, ER+ breast cancer incidence correlates strongly with aging, rising to a peak incidence in women aged 70 years or older (elderly). Owing in large part to the differences in physiologic estrogen signaling and the chronic inflammatory state that develops as people age, ER+ breast cancer that develops in the elderly population exhibits distinct clinical and biological behavior from ER+ breast cancer in younger cohorts. Clinically, while endocrine therapy continues to be a mainstay of treatment, there is a major push for de-implementation of invasive and adverse effect-causing interventions in the elderly that do not impact disease-specific survival. Our group has recently shown that in elderly patients with early stage ER+, clinically node-negative tumors, de-implementation of both sentinel lymph node biopsy and radiation therapy can be safely omitted without compromising local recurrence-free or disease-free survival. Biologically, intrinsic epigenomic and transcriptomic as well as changes to local breast microenvironment all contribute to a unique landscape for tumor pathogenesis in aged individuals. The interplay and disease-causing roles of these factors requires further investigation.
Education & Training
- MSTP, University of Pittsburgh School of Medicine
- BS, Carnegie Mellon University
Ghosh-Choudhary S, Carleton N, Nouraie SM, Kliment CR, Steinman RA. Predoctoral MD-PhD grants as indicators of future NIH funding success. JCI Insight. 2022 Mar 22;7(6):e155688. doi: 10.1172/jci.insight.155688. PMID: 35315356.
Carleton N, Nasrazadani A, Gade K, Beriwal S, Barry PN, Brufsky AM, Bhargava R, Berg WA, Zuley ML, van Londen GJ, Marroquin OC, Thull DL, Mai PL, Diego EJ, Lotze MT, Oesterreich S, McAuliffe PF, Lee AV. Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women. Lancet Healthy Longev. 2022 Jan;3(1):e54-e66. doi: 10.1016/s2666-7568(21)00280-4. Epub 2022 Jan 5. PMID: 35047868; PMCID: PMC8765742.
Carleton N, Zou J, Fang Y, Koscumb SE, Shah OS, Chen F, Beriwal S, Diego EJ, Brufsky AM, Oesterreich S, Shapiro SD, Ferris R, Emens LA, Tseng G, Marroquin OC, Lee AV, McAuliffe PF. Outcomes After Sentinel Lymph Node Biopsy and Radiotherapy in Older Women With Early-Stage, Estrogen Receptor-Positive Breast Cancer. JAMA Netw Open. 2021 Apr 1;4(4):e216322. doi: 10.1001/jamanetworkopen.2021.6322. PubMed PMID: 33856473.
Ghosh-Choudhary S, Carleton N, Flynn JL, Kliment CR. Strategies for Achieving Gender Equity and Work-Life Integration in Physician-Scientist Training. Acad Med. 2021 Jul 20;. doi: 10.1097/ACM.0000000000004246. PubMed PMID: 34292189.
Chen F, Ding K, Priedigkeit N, Elangovan A, Levine KM, Carleton N, Savariau L, Atkinson JM, Oesterreich S, Lee AV. Single-Cell Transcriptomic Heterogeneity in Invasive Ductal and Lobular Breast Cancer Cells. Cancer Res. 2021 Jan 15;81(2):268-281. doi: 10.1158/0008-5472.CAN-20-0696. Epub 2020 Nov 4. PubMed PMID: 33148662.