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Background: With a globally increasing population of otherwise healthy people above 70 years, more knowledge on treatment and prognosis of breast cancer patients in this group is needed. In Denmark, the Danish Breast Cancer Group describes national treatment guidelines for diagnostic work-up and surgical and oncological treatment of all patients with primary invasive breast cancer with no upper age limit. Still, many patients ≥70 years, regardless of comorbidity, do not adhere to treatment guidelines, often receiving less imaging and less treatment than recommended. The aims of the present study were to examine, among patients ≥70 years with primary invasive breast cancer, whether endocrine treatment only, resulted in an inferior breast cancer related survival compared to standard surgical and oncological treatment, to examine whether patients treated with breast conserving surgery (BCS) with no preoperative imaging had a higher risk of local recurrence than patients receiving preoperative imaging, and finally to examine whether clinically node negative patients had a higher risk of regional recurrence if they did not receive axillary staging. Methods: All women, ≥70 years, diagnosed with primary invasive breast cancer and treated at the Department of Breast Surgery at Herlev Hospital, Denmark, from 2000-2007 were included. Patients were prospectively registered in a hospital-based database. Differences in standardized mortality ratios (SMR) between patients treated by surgery, endocrine therapy only, or endocrine therapy followed by surgery were estimated by Poisson regression and evaluated by rate ratios. Differences in local recurrence between patients with and without preoperative imaging before BCS, and in regional recurrence between surgically treated patients with and without a sentinel lymph node biopsy, with axillary clearance in case of a positive sentinel node, excluding clinically node positive patients directly treated with an axillary clearance, were estimated by Cause Specific Hazards Models and evaluated by cause specific hazard ratios (HR). Adjustments were made for age, comorbidity, adjuvant radiotherapy, tumor size, time since diagnosis, and time period. Results: In total 1,142 patients were included in the study. The median age was 77 years. For overall mortality, median follow-up was 7.80 years, with 795 (69.6%) dying during follow-up, and for recurrence 6.25 years. 52 were registered with local recurrence and 39 with regional recurrence. Patients who received only endocrine therapy had a significantly higher SMR than patients treated with primary surgery (adj. RR=2.57; 95% CI: 2.01-3.30), while patients who received endocrine therapy followed by later surgery did not (RR=1.23; 95% CI: 0.91-1.66). 253 out of 580 patients with BCS (43.6%) did not have preoperative imaging. Patients without imaging did not have a higher risk of local recurrence compared to patients with preoperative imaging (adj. HR=1.14; 95% CI: 0.36-3.67). 13 out of 197 surgically treated patients without axillary surgery (6,8%) had regional recurrence, while only 7 out of 428 patients (1.6%) with axillary staging by sentinel node biopsy had regional recurrence. This difference was significant (adj. HR 4.68 95% CI=1.53-14.37). Conclusions: In the present study we have shown that women ≥70 years, diagnosed with primary invasive breast cancer, have a higher mortality if they are not surgically treated, and they have a higher risk of regional recurrence if they are not offered axillary staging. The study emphasizes that unless elderly patients have comorbidity contraindicating surgery, they should be treated according to guidelines. Citation Format: Mathias Kvist Mejdahl, Mette Haulund Christensen, Birgitte Paaschburg Nielsen, Tove HolstFiltenborg Tvedskov. Elderly breast cancer patients benefit from surgery according to guidelines [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-07.

Purpose To investigate among women ≥ 70 years with early stage invasive breast cancer, whether primary endocrine therapy and omission of surgery resulted in an inferior relative survival, whether the omission of preoperative imaging resulted in an inferior local control, and whether the omission of axillary staging resulted in an inferior regional control and inferior relative survival. Methods A single center retrospective cohort study at Herlev Hospital, Denmark. Relative survival was expressed as standardized mortality ratios (SMR) and differences were estimated using Poisson regression and evaluated by rate ratios (RR). Differences in local and in regional recurrence were estimated by a Cause Specific Hazard Model and evaluated by hazard ratios (HR). Models were adjusted for age, comorbidity, and tumor size. Results We identified 1,142 women. Patients who received only endocrine therapy had a higher SMR than patients treated with primary surgery (RR = 2.57;95%CI:2.01–3.30). Patients treated with primary breast conserving surgery (BCS) did not have a lower risk of local recurrence if they received preoperative imaging (HR = 0.88;95%CI:0.27–2.81). Finally, patients who received an axillary staging had a lower risk of regional recurrence compared to patients who did not receive axillary surgery (HR = 0.25;95%CI:0.08–0.84), but not a statistically significant superior relative survival (RR = 0.78;95%CI:0.60-1.00). Conclusion Elderly women with early stage breast cancer treated with only endocrine therapy had an inferior relative survival, omission of axillary staging resulted in a higher risk of regional recurrence and a tendency to an inferior relative survival, and omission of preoperative imaging before BCS did not result in a higher risk of local recurrence.

Radioisotope bone scanning is a sensitive indicator of metastatic disease. Localization of the hot spot for biopsy is difficult. Today, a hand-held gamma probe enables the surgeon intraoperatively to accomplish the localization procedure easily. As this technique is described in American literature exclusively, more recent European findings is presented here. During one month two patients were diagnosed with breast cancer. Bone scanning disclosed minor hot spots in the ribs. On the day of surgical biopsy the localization of the hot spots was guided by a gamma probe. For the biopsy a dermal punch biopsy needle was employed, and fine needle aspiration biopsies were also taken. The procedures were easy and completed within a few minutes. The post-operative courses were uneventful. In one patient, final histology showed malignancy in both biopsies. In the other patient, only the fine needle aspiration biopsy was malignant. The punch biopsy was abnormal, but did not contain malignant tissue. The gamma probe is an important tool in the performance of rib biopsies of nonpalpable lesions. The punch biopsy technique is simple and combined with fine needle aspiration biopsy the method has proven to be sensitive and accurate. The punch biopsy technique furthermore reduces the risk of postoperative pneumothorax.

On the basis of an analysis in 118 patients with space occupying lesions in the kidney demonstrated on the pyelogram it is conluded, that the combination of intravenous pyelography and fine needle aspiration biopsy is a safe diagnostic procedure, and it could be a valuable supplement to angiography and explorative incision.