Skip to main content

Advertisement

SpringerLink
Log in

Early-Stage Breast Cancer in the Octogenarian: Tumor Characteristics, Treatment Choices, and Clinical Outcomes

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nodal staging with sentinel node biopsy (SLNB), post-lumpectomy radiotherapy (RT), and endocrine therapy (ET) for estrogen receptor-positive (ER+) tumors is valuable in the treatment of early-stage (stages 1 or 2) breast cancer but used less often for elderly women.

Methods

This retrospective study investigated women referred for surgical evaluation of biopsy-proven primary early-stage invasive breast cancer from January 2001 to December 2010. Clinicopathologic features, treatment course, and outcomes for women ages 80–89 years and 50–59 years were compared.

Results

The study identified 178 eligible women ages 80–89 years and 169 women ages 50–59 years. The elderly women more often had grade 1 or 2 disease (p = 0.003) and ER+ tumors (p = 0.007) and less frequently had undergone adjuvant therapies (all p ≤ 0.001). Lumpectomy was performed more commonly for the elderly (92 vs. 83 %, p = 0.02), and axillary surgery was less commonly performed (46 vs. 96 %; p < 0.001). Fewer elderly women had undergone post-lumpectomy RT (42 vs. 89 %; p < 0.001) and ET for ER+ tumors (72 vs. 95 %; p < 0.001). During the median follow-up period of 56 months for the 80- to 89-year old group and 98 months for the 50- to 59-year-old group, death from breast cancer was similar (4 vs. 5 %; p = 0.5). The two groups respectively experienced 7 versus 6 locoregional recurrences and 11 versus 13 distant recurrences.

Conclusions

The octogenarians had disease survivorship similar to that of the younger women despite less frequent use of adjuvant therapies, likely reflecting lower-risk disease features. Whether increased use of axillary surgery, post-lumpectomy RT, and/or ET for ER+ tumors would further improve outcomes is an important area for further study, but treatment should not be deferred solely on the basis of age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Freedman RA. Treatment of breast cancer in the elderly. Curr Oncol Rep. 2015;17:51.

    Article  PubMed  Google Scholar 

  2. Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol. 2010;28:2038–45.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.

    Article  CAS  PubMed  Google Scholar 

  4. Townsley CA, Selby R, Siu LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol. 2005;23:3112–24.

    Article  PubMed  Google Scholar 

  5. Enger SM, Thwin SS, Buist DS, et al. Breast cancer treatment of older women in integrated health care settings. J Clin Oncol. 2006;24:4377–83.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wyld L, Garg DK, Kumar ID, Brown H, Reed MW. Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines. Br J Cancer. 2004;90:1486–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hurria A, Leung D, Trainor K, Borgen P, Norton L, Hudis C. Factors influencing treatment patterns of breast cancer patients age 75 and older. Crit Rev Oncol Hematol. 2003;46:121–6.

    Article  PubMed  Google Scholar 

  8. Freedman RA, Vaz-Luis I, Barry WT, et al. Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy. Breast Cancer Res Treat. 2014;145:491–501.

    Article  CAS  PubMed  Google Scholar 

  9. Yood MU, Owusu C, Buist DS, et al. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206:66–75.

    Article  PubMed  Google Scholar 

  10. Bouchardy C, Rapiti E, Fioretta G, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.

    Article  PubMed  Google Scholar 

  11. Wanebo HJ, Cole B, Chung M, et al. Is surgical management compromised in elderly patients with breast cancer? Ann Surg. 1997;225:579–86; discussion 586–79.

  12. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  13. Hoyert D, Xu J. Deaths: preliminary data for 2011. National Vital Statistics Reports. 2012:61(6). National Center for Health Statistics, Hyattsville, MD.

  14. Howlader N, Altekruse SF, Li CI, et al. U.S. incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014;106:dju055.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Angarita FA, Chesney T, Elser C, Mulligan AM, McCready DR, Escallon J. Treatment patterns of elderly breast cancer patients at two Canadian cancer centres. Eur J Surg Oncol. 2015;41:625–34.

    Article  CAS  PubMed  Google Scholar 

  16. Cyr A, Gillanders WE, Aft RL, Eberlein TJ, Margenthaler JA. Breast cancer in elderly women (≥80 years): variation in standard of care? J Surg Oncol. 2011;103:201–6.

    Article  PubMed  Google Scholar 

  17. Karam AK, Hsu M, Patil S, et al. Determinants of outcome in elderly patients with positive sentinel lymph nodes. Am J Surg. 2011;201:734–40.

    Article  PubMed  Google Scholar 

  18. van de Water W, Seynaeve C, Bastiaannet E, et al. Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: a tamoxifen exemestane adjuvant multinational study analysis. Oncologist. 2013;18:8–13.

    Article  Google Scholar 

  19. Goyal A, Douglas-Jones A, Newcombe RG, Mansel RE. Predictors of non-sentinel lymph node metastasis in breast cancer patients. Eur J Cancer. 2004;40:1731–7.

    Article  CAS  PubMed  Google Scholar 

  20. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8.

    Article  CAS  PubMed  Google Scholar 

  21. Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst. 2006;98:599–609.

    Article  Google Scholar 

  22. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 noninferiority trial. Lancet Oncol. 2014;15:1303–10.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vaz-Luis I, Keating NL, Lin NU, Lii H, Winer EP, Freedman RA. Duration and toxicity of adjuvant trastuzumab in older patients with early-stage breast cancer: a population-based study. J Clin Oncol. 2014;32:927–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sail KR, Franzini L, Lairson DR, Du XL. Clinical and economic outcomes associated with adjuvant chemotherapy in elderly patients with early-stage operable breast cancer. Value Health. 2012;15:72–80.

    Article  PubMed  Google Scholar 

  25. Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004;351:963–70.

    Article  CAS  PubMed  Google Scholar 

  26. Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  28. Martelli G, Boracchi P, Guzzetti E, et al. Omission of radiotherapy in elderly patients with early breast cancer: 15-year results of a prospective non-randomised trial. Eur J Cancer. 2015;51:1358–64.

    Article  PubMed  Google Scholar 

  29. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.

  30. Murphy CT, Li T, Wang LS, et al. Comparison of adjuvant radiation therapy alone versus radiation therapy and endocrine therapy in elderly women with early-stage, hormone receptor-positive breast cancer treated with breast-conserving surgery. Clin Breast Cancer. 2015;16:381–9.

    Article  Google Scholar 

Download references

Acknowledgments

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and with financial contributions from Harvard University and its affiliated academic health care centers.

Conflict of Interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Anita Mamtani MD, Julie J. Gonzalez Bsc, Mary Jane Houlihan MD & Ranjna Sharma MD

  2. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Dayna Neo MPH & Michele R. Hacker ScD, MSPH

  3. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Priscilla J. Slanetz MD, MPH

  4. Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Christina I. Herold MD

  5. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Abram Recht MD

Authors
  1. Anita Mamtani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie J. Gonzalez Bsc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dayna Neo MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Priscilla J. Slanetz MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary Jane Houlihan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christina I. Herold MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abram Recht MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michele R. Hacker ScD, MSPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ranjna Sharma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ranjna Sharma MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mamtani, A., Gonzalez, J.J., Neo, D. et al. Early-Stage Breast Cancer in the Octogenarian: Tumor Characteristics, Treatment Choices, and Clinical Outcomes. Ann Surg Oncol 23, 3371–3378 (2016). https://doi.org/10.1245/s10434-016-5368-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5368-z

Keywords

Search

Navigation