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Outcomes After Mastectomy and Lumpectomy in Elderly Patients with Early-Stage Breast Cancer

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

Abstract

Introduction

Survival in elderly patients undergoing mastectomy or lumpectomy has not been specifically analyzed.

Methods

Patients older than 70 years of age with clinical stage I invasive breast cancer, undergoing mastectomy or lumpectomy with or without radiation, and surveyed within 3 years of their diagnosis, were identified from the Surveillance, Epidemiology, and End Results and medicare health outcomes survey-linked dataset. The primary endpoint was breast cancer-specific survival (CSS).

Results

Of 1784 patients, 596 (33.4 %) underwent mastectomy, 918 (51.4 %) underwent lumpectomy with radiation, and 270 (15.1 %) underwent lumpectomy alone. Significant differences were noted in age, tumor size, American Joint Committee on Cancer (AJCC) stage, lymph node status (all p < 0.0001) and number of positive lymph nodes between the three groups (p = 0.003). On univariate analysis, CSS for patients undergoing lumpectomy with radiation [hazard ratio (HR) 0.61, 95 % confidence interval (CI) 0.43–0.85; p = 0.004] was superior to mastectomy. Older age (HR 1.3, 95 % CI 1.09–1.45; p = 0.002), two or more comorbidities (HR 1.57, 95 % CI 1.08–2.26; p = 0.02), inability to perform more than two activities of daily living (HR 1.61, 95 % CI 1.06–2.44; p = 0.03), larger tumor size (HR 2.36, 95 % CI 1.85–3.02; p < 0.0001), and positive lymph nodes (HR 2.83, 95 % CI 1.98–4.04; p < 0.0001) were associated with worse CSS. On multivariate analysis, larger tumor size (HR 1.89, 95 % CI 1.37–2.57; p < 0.0001) and positive lymph node status (HR 1.99, 95 % CI 1.36–2.9; p = 0.0004) independently predicted worse survival.

Conclusions

Elderly patients with early-stage invasive breast cancer undergoing breast conservation have better CSS than those undergoing mastectomy. After adjusting for comorbidities and functional status, survival is dependent on tumor-specific variables. Determination of lymph node status remains important in staging elderly breast cancer patients.

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Acknowledgment

This study was supported by Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.

Conflicts of interest

Harveshp D. Mogal, Clancy Clark, Rebecca Dodson, Nora F. Fino, and Marissa Howard-McNatt have no conflicts of interest to declare.

Ethics statement

Institutional Review Board approval was obtained for this study.

Funding

None.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Harveshp D. Mogal MD, Clancy Clark MD, Rebecca Dodson MD & Marissa Howard-McNatt MD

  2. Department of Biostatistical Sciences, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA

    Nora F. Fino MS

Authors
  1. Harveshp D. Mogal MD
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  2. Clancy Clark MD
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  3. Rebecca Dodson MD
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  4. Nora F. Fino MS
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  5. Marissa Howard-McNatt MD
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Corresponding author

Correspondence to Marissa Howard-McNatt MD.

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Mogal, H.D., Clark, C., Dodson, R. et al. Outcomes After Mastectomy and Lumpectomy in Elderly Patients with Early-Stage Breast Cancer. Ann Surg Oncol 24, 100–107 (2017). https://doi.org/10.1245/s10434-016-5582-8

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  • DOI: https://doi.org/10.1245/s10434-016-5582-8

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