Evolution of older patients diagnosed with early breast cancer in Spain between 1998 and 2001 included in El Alamo III project
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An increase in the number of cancer cases is expected in the near future. Breast cancer (BC) mortality rates increase with age even when adjusted for other variables. Here we analyzed BC disease-free survival (BCDFS) and BC specific survival (BCSS) in the El Alamo III BC registry of GEICAM Spanish Breast Cancer Group.
Materials and methods
El Alamo III is a retrospective registry of BC patients diagnosed between 1998 and 2001. Patients with stage I–III invasive BC of age groups 55–64 years (y), 70–74 years and ≥ 75 years were included. Patients and tumors characteristics, treatments and recurrences and deaths were analyzed.
4343 patients were included within the following age intervals: 2288 (55–64 years), 960 (70–74 years), and 1095 (≥ 75 years). Older patients (≥ 70 years) were diagnosed with more advanced tumors (stage III) than younger patients (21.5% versus 13.4%, p < 0.0001). Mastectomies were performed more on older patients and they received less chemotherapy than younger patients (66.6% versus 43.1%, p < 0.00001 and 30.8% versus 71.6%, p < 0.0001, respectively). With a median follow-up of 5.9 years, 17.7% patients had BCDFS events in the younger group and 19.8% in the older group (p < 0.0001). A decrease in BCSS was also observed in older patients, either when analyzing patients ≥ 70y (p < 0.0001) and when differentiating by the two older groups (p < 0.0001).
Our study suggests that older BC patients have worse outcomes what can be a consequence of receiving inadequate adjuvant treatments. Specific trials for these patients are warranted to allow us to treat them with the same scientific rigor than younger patients.
KeywordsOlder patients Early breast cancer Adjuvant treatment Survival Undertreatment
This analysis has not received any external funding. All costs were covered by GEICAM, Spanish Breast Cancer Group. The original ALAMO III was funded by BMS, Roche, Lilly, Novartis, GSK and Pfizer.
Compliance with ethical standards
Conflict of interest
Dr García-Sáenz has received consultancy/speaker fees from Novartis, Celgene, Lilly, EISAI and Roche. Travel support from Novartis, Roche, Pfizer and his institution research funding from AstraZeneca. The rest of authors declared no conflicts of interest.
Data were collected following the requirements of the Spanish legislation for privacy data protection in the considered period. The information collected by the investigators (doctors and health care personnel) was retrospective information that already existed in the patient’s clinical history. The information collected did not contain any personal data. The specific regulation for observational retrospective studies, like El Álamo, was developed in Spain at 2009 with the ORDER SAS/3470/2009, of December 16th, which publishes guidelines on post-authorization observational studies for drugs for human use. From this moment on, observational retrospective studies have a specific regulation that did not exist before. This is the reason why the IRBs in Spain did not reviewed nor approved any observational retrospective study before this legislation was developed.
According to regulations in force (Order SAS), the informed consent of the subjects is not required since: 1) in the process of data collection retrospectively, a secure dissociation procedure is adopted, ensuring that the information handled in the study does not contain personal data and 2) personal interviews are not required nor are biological samples collected from patients. Each patient received a number identification of participation in the study and patient’s data confidentiality and compliance with the ethical rules was guaranteed.
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