Surgery Is Associated with Lower Morbidity and Longer Survival in Elderly Breast Cancer Patients over 80

Abstract

As breast cancer is the most frequent cancer in the elderly with a peak incidence of 1 in 10 by the age of 80, it is important to establish optimum therapy in this group. We conducted a case note-based retrospective study of all elderly primary breast cancer patients aged 80 and above between 1992 and 2002. The type of treatment, complications, disease progression, recurrence, and overall survival were recorded. In all 110 patients aged 80 and above were treated for primary breast cancer, with 32 patients having advanced disease. Of these, 62 patients received primary endocrine treatment. 48 patients underwent surgery with 30 patients undergoing mastectomy. At follow-up, 34 patients suffered disease progression in the primary endocrine treatment group and three patients had local recurrence in the surgical group. The Kaplan-Meier analysis revealed significantly better survival in the surgical treatment group when compared with the primary endocrine treatment group, both in the early disease (n = 41; median survival: 71 months; compared to n = 37; median survival: 42 months; p = 0.0002) and the advanced disease (n = 7; median survival: 48 months; compared to n = 25; median survival: 36 months; p = 0.03). Prompt surgery and adjuvant treatment can decrease relapse and improve survival even in patients older than 80 years.

Surgery improves breast cancer-specific survival in octogenarians with early-stage breast cancer

“…In the GRETA trial, 15 surgery (radical or minimal) followed by adjuvant tamoxifen does not modify overall and breast cancer survival as compared with tamoxifen alone; however, in those patients who received the primary endocrine treatment, there was a high rate of local progression. Also, better survival in the surgical treatment group when compared with the primary endocrine treatment group was documented in the study of Rao et al 9 In our study, breast cancer-specific survival was significantly better in the surgical group but only in patients with early-stage breast cancer, whereas differences in the modality of treatment in patients with locally advanced breast cancer were not found.…”

“…7,8 Primary endocrine therapy is sometimes substituted for operation, and axillary surgery, adjuvant chemotherapy and adjuvant radiotherapy are frequently omitted. 9 A Cochrane review of surgery versus primary endocrine therapy for operable primary breast cancer in women 70 years or over showed that surgery controls breast cancer better than tamoxifen alone with significant differences in progressionfree survival, but does not extend overall survival. 10 Moreover, much of the literature defines "elderly" very broadly, including women as young as 65 or even excluding women over 80 from studies focused on older breast cancer patients.…”

6. Case mix does not fully explain variation in rates of non-surgical treatment of older women with operable breast cancer

“…This may be due to the fact that affluence is associated with lower levels of comorbidity and smoking, and greater longevity and education (27) , thereby promoting better health and discussion of treatment options. Higher levels of comorbidity were also associated with nonsurgical treatment, which is also consistent with other published studies, where co-morbidity is stated as a major reason for choosing PET over surgery (28)(29)(30) . Tumour factors were also associated with treatment type, with larger, node positive tumours being less likely to be treated surgically which may represent patients and clinicians trying to avoid more major surgery, such as mastectomy and axillary node clearance.…”

Breast cancer in women 80 years of age and older: A comprehensive analysis of an underreported entity

“…However, when reviewing the literature which explicitly reports on BC therapy in the elderly, it becomes quickly apparent that most studies analyzed patients in their 60s and 70s, and women older than 80 were often not included or comprised a negligible minority of the cohorts analyzed [1][2][3][4][5][6]10]. Studies focusing on patients who are > 80 years of age and thus represent the oldest 10% of the entire BC cohort are scarce [4,7,[11][12][13]. To our knowledge, our study is the first comprehensive description of an unselected cohort of this particular subgroup of patients.…”