Association Between Age at Diagnosis and Disease-Specific Mortality Among Postmenopausal Women With Hormone Receptor–Positive Breast Cancer

Abstract

Context In addition to classic tumor-related prognostic factors, patient characteristics may be associated with breast cancer outcome. Objective To assess the association between age at diagnosis and breast cancer outcome in postmenopausal women with hormone receptor-positive breast cancer. Design, Setting, and Patients Study analysis of 9766 patients enrolled in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) randomized clinical trial between January 2001 and January 2006. Age at diagnosis was categorized as younger than 65 years (n=5349), 65 to 74 years (n=3060), and 75 years or older (n=1357). Main Outcome Measures Primary end point was disease-specific mortality; secondary end points were other-cause mortality and breast cancer relapse. Results During median follow-up of approximately 5.1 years, there were a total of 1043 deaths. Disease-specific mortality, as a proportion of all-cause mortality, decreased with categorical age group (78% [Ͻ65 years], 56% [65-74 years], and 36% [Ն75 years]; PϽ.001). In multivariable analyses, compared with patients younger than 65 years, disease-specific mortality increased with age for patients aged 65 to 74 years (hazard ratio [HR], 1.25; 95% CI, 1.01-1.54); and patients aged 75 years or older (HR, 1.63; 95% CI, 1.23-2.16) (PϽ.001). Similarly, breast cancer relapse increased with age for patients aged 65-74 years (HR, 1.07; 95% CI, 0.91-1.25 and patients aged 75 years or older (HR, 1.29; 95% CI, 1.05-1.60) (P=.06). Other-cause mortality increased with age in patients aged 65 to 74 years (HR, 2.66; 95% CI, 1.96-3.63) and patients aged 75 years or older (HR, 7.30; 95% CI, 5.29-10.07) (PϽ.001). Conclusion Among postmenopausal women with hormone receptor-positive breast cancer, increasing age was associated with a higher disease-specific mortality.

Treatment of Primary Breast Cancer at the Surgical Unit of the Charité 1984-1998

“…According to van de Water et al [28], death specifically caused by breast cancer in postmenopausal women receiving hormones after an average follow-up of 5.1 years amounts to 78% for women of < 65 years of age, to 56% for women between 65 and 75 years, and to 36% for women > 75 years.…”

A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition

“…Synchronous breast cancer is diagnosed when a contralateral breast carcinoma occurs simultaneously or within 3 months of the primary, whereas metachronous bilateral breast cancer is considered when it occurs more than 3 months after diagnosis of the first tumor [23]. However, from an epidemiological standpoint, an interval of 12 months might be considered more appropriate [24]. Bilateral breast cancer needs to be distinguished from metastatic cancer in the contralateral breast, which is a much rarer situation.…”

Patient's Anastrozole Compliance to Therapy (PACT) Program: Baseline Data and Patient Characteristics from a Population-Based, Randomized Study Evaluating Compliance to Aromatase Inhibitor Therapy in Postmenopausal Women with Hormone-Sensitive Early Breast Cancer

“…It is possible that clinicians are selecting mastectomy over BCS in more elderly patients to minimize the need for radiotherapy, which is less well tolerated by these patients. This option may appear preferable for patients who have concerns about the safety or efficacy of radiotherapy versus surgery [21,22], and such practices have been reported previously in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) and Intergroup Exemestane Study (IES) trials [23,24]. In the overall PACT population, the majority of patients received BCS.…”