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Introduction. Breast cancer (BC) is most frequently diagnosed in women over 60 years of age. Histological grade (HG) is a key prognostic marker; however, its distribution and clinical interpretation vary across age groups.
Aim. To evaluate the distribution of HG in invasive BC in biopsy and surgical specimens according to patient age and to identify discrepancies between specimen types.
Materials and Methods. This retrospective study included data from 16,150 patients with invasive BC (biopsy specimens, n = 5,571; surgical specimens, n = 10,579) treated at the N.N. Petrov National Medical Research Center of Oncology between 2015 and 2023. HG was assessed using the Nottingham grading system. Statistical analysis was performed using the χ² test and linear trend assessment.
Results. In biopsy specimens, the proportion of grade 3 tumors decreased with age: from 44.3% in patients < 35 years to 24.9 % in those 75–89 years (p = 0.0003). Grade 2 predominated across all age cohorts (53.0–63.7 %). In surgical specimens, the highest proportion of grade 3 was observed in the < 35 years group (53.4 %), with an early crossover to grade 2 occurring in the 35–44 years interval. Statistically significant differences between biopsy and surgical specimens were found in the < 35 years (p < 0.001) and 75–89 years (p = 0.013) groups. Grade 2 remained the most heterogeneous category, warranting additional immunohistochemical and molecular genetic evaluation.
Conclusion. Age-related HG dynamics in this cohort did not reproduce the classic grade 2/3 crossover typically reported in the 45–59 years group. In patients ≥ 60 years, interpretation of histological grade should be integrated with molecular subtype, genomic profiling, and comprehensive geriatric assessment to support treatment de-escalation decisions.
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