A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Abstract

Funding: There was no specific funding for this study. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ςαριατιον ιν Προγνοσισ ς28 17 10 2013.δοχξ 2 *Manuscript Click here to view linked References AbstractBackground: Deprivation, non-white ethnicity and young age are associated with late

Treatment strategies and survival outcomes in older women with breast cancer: A comparative study between the FOCUS cohort and Nottingham cohort

“…PET was the predominant primary treatment option in the Nottingham cohort and was used for a far smaller proportion of patients in the FOCUS cohort. This finding corresponds to the results found in previous studies including smaller cohort studies, cancer registry findings and a UK breast surgeon survey on treatment of older patients [17][18][19][20]. Growing evidence suggest poor locoregional control with PET: systemic literature review of randomised controlled trials and non-randomised studies has shown benefits for surgery over PET in treatment of older patients in improving disease control and a probable survival benefit in patients with a life expectancy of five years or more [21,22].…”

Addressing frailty in patients with breast cancer: A review of the literature

“…Specifically, it is only in the presence of poor functional status and cognitive impairment that multiple comorbidities is associated with post-operative mortality and functional decline [61]. Despite this, studies repeatedly report a lower rate of surgical resection for older patients with breast cancer, based on age and comorbidity profile [3,4]. This is particularly the case in patients with oestrogen receptor (ER-) positive disease for which primary endocrine therapy (PET) is available as an 'alternative' treatment [5], despite the inferiority of PET on disease-free survival [62].…”

“…Older women are less likely to receive surgery for operable breast cancer [3,4]. Among those older women who do receive surgery, this is more likely to be a mastectomy than breast conserving surgery (BCS) [5], and of those women having BCS, they are less likely to have adjuvant radiotherapy [6,7].…”

“…On average, older women tend to have larger tumours at diagnosis [9], which is partly a consequence of being older than the inclusion ages (usually 50e70 years) of women in national breast screening programmes. The higher burden of comorbid conditions among older women may also be a significant contributing factor, with various studies showing lower rates of surgery [3] and other therapies [10,11] among women with more comorbid conditions. However, these factors only explain some of the reported variation in treatment patterns between younger and older women.…”

Metabolic syndrome and pre‐diabetes contribute to racial disparities in breast cancer outcomes: hypothesis and proposed pathways

“…We will use the NPI rather than cancer stage at presentation to determine prognosis at the time of tumour resection, as the NPI is less affected by health care access than tumour stage and has been validated in several different countries [26,31,32]. To ensure that the NPI is accurately portraying recurrence risk, we will conduct a small validation study in year 4 of the study as the majority of early recurrences occur within the first 2 years of initial treatment [33].…”