The effect of under-treatment of breast cancer in women 80 years of age and older

Van Leeuwen, Barbara L.; Rosenkranz, K.M.; Lei Feng, L.; Bedrosian, I.; Hartmann, K.; Hunt, K.K.; Kuerer, H.M.; Ross, M.; Singletary, S.E.; Babiera, Gildy V.; the Department of Surgical Oncology, MD Anderson Cancer Center,

doi:10.1016/j.critrevonc.2010.05.010

« Previous Next »Critical Reviews in Oncology / Hematology
Volume 79, Issue 3 , Pages 315-320, September 2011

The effect of under-treatment of breast cancer in women 80 years of age and older

Barbara L. Van Leeuwen
- University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700 RB Groningen, The Netherlands
- Corresponding author. Tel.: +31 503612317.
K.M. Rosenkranz
- 1 Medical Center Drive, Lebanon, NH 03756, United States
- Tel.: +1 603 650 9479; fax: +1 603 650 8030.
L. Lei Feng
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
I. Bedrosian
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
K. Hartmann
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
K.K. Hunt
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
H.M. Kuerer
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
M. Ross
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
S.E. Singletary
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
Gildy V. Babiera
- MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd. Unit 444, Houston, TX 77030, United States
- Tel.: +1 713 7451563; fax: +1 713 4044572.
the Department of Surgical Oncology, MD Anderson Cancer Center
- The Department of Surgical Oncology, MD Anderson Cancer Center includes Feig B, Ames F, Hwang R, Lucci A and Meric-Bernstam F.

Accepted 27 May 2010. published online 26 July 2010.

Abstract

Background

Several authors have demonstrated a trend toward the under-treatment of elderly and very elderly women with breast cancer. This study was undertaken to determine the impact of under-treatment of breast cancer in women age 80 and older.

Methods

A retrospective chart review of all patients 80 years and older with a newly diagnosed breast cancer at the MD Anderson Cancer Center, Houston, TX, between September 1, 1989 and September 1, 2004 was performed. Data extracted from charts included patient demographics, comorbidity, treatments recommended, treatments received, complications of therapy, disease recurrence and disease related death. Treatments undertaken were analyzed in the context of accepted therapy at the time of diagnosis.

Results

Two hundred twelve patients were identified. The median age was 83.5 years (range 80–97). Overall survival in the entire cohort was 7.28 years with a median follow up of 4 years for patients still alive at the end of the study period. Fifty seven percent of patients were under-treated according to institutional and national guidelines. Women who underwent hormonal therapy only demonstrated decreased disease specific survival (P<0.001 respectively) compared with patients who received multi-modality therapy. Women who underwent partial mastectomy without radiation treatment experienced a significant increase in local regional recurrence (P=0.045). There was an association of increased disease specific survival in patients who had surgical lymph node evaluation compared to those who did not (P=0.04).

Conclusions

Outcomes are compromised in very elderly women with breast cancer in whom less than complete combined modality treatment is undertaken. With the previously demonstrated safety of radiation therapy, hormonal therapy and surgery in the very elderly population, multi-modality therapy should not be routinely withheld in patients in this age category.

Keywords: Elderly, Breast cancer, Surgery