Surgery yields positive outcomes in elderly women with early-stage breast cancer
Elderly women presenting with early stage breast cancer fare well when treated with surgery, according to a recent Singapore study.
“Treatment with surgery for early breast cancer yielded good outcomes in the elderly with survival similar to that of younger patients, better than nonsurgical treatment, and nonsurgical treatment was better than no treatment,” said the researchers.
In patients with stage I disease, 5-year breast cancer specific survival postsurgery was comparable between elderly and younger patients (96.1 percent vs 99 percent). However, elderly patients with stage III disease fared worse than younger patients regardless of treatment option. [Breast 2017;36:44-48]
The study population comprised Singaporean women who were diagnosed with breast cancer between 2003 and 2014 (n=19,314), based on the Singapore Cancer Registry. Patients with unknown disease stage were excluded (n=1,482) and the remaining patients were divided into two groups based on age (<80 [n=17,159] and ≥80 years [n=673]), while treatment was divided into three groups (surgery, nonsurgical treatment [≥1 treatment consisting of endocrine, radiation, anti-HER2 therapy, or chemotherapy], or no treatment).
Patients aged ≥80 years were more likely to present with late stage disease (stage III and IV) than their younger counterparts (41 percent vs 28.3 percent). Elderly patients with stage I–III disease (curative) were less likely to be treated with surgery than younger patients (61.4 percent vs 92.5 percent).
Elderly patients also had a reduced likelihood of undergoing chemotherapy and radiation therapy alongside surgery compared with younger patients (chemotherapy: 2.9 percent vs 53.0 percent, radiotherapy: 16.5 percent vs 35.6 percent), though they were more likely to undergo hormonal therapy (55.2 percent vs 42.8 percent).
“There are existing guidelines that help to guide the management of breast cancer in elderly patients, but physicians still face challenges in identifying candidates for the appropriate management,” said the researchers.
“Although surgery is potentially curative, extremely elderly patients are treated conservatively because of advanced age, presence of comorbidities, frailty, [or] poor functional status or social support.”
“Surgery for breast cancer is safe for elderly women, especially for those with little or no comorbidities and should be based on functional status and severity of comorbidities rather than chronological age.”
“The decision to perform surgery in those with stage III disease should be personalized, taking into consideration the patient’s biological age with risk stratification of their fitness to withstand the different treatment modalities,” said the researchers.
Study limitations included lack of information on tumour hormone receptor status, functional status, and comorbidities.
“[D]etails of breast and axillary surgery were [also] not available to assess if the nonsurgery option or suboptimal surgery was due to subjective physician assessments,” the researchers said.