Breast cancer in the elderly: Surgery improves survival. The results of a cancer research campaign trial

Bates, Tom; Fennessy, Michelle M.; Riley, Diana; Baum, M; Houghton, J; MacRae, K D

doi:10.1016/s0959-8049(01)80052-6

Cited by 20 publications

(14 citation statements)

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“…tamoxifen as sole treatment) in older women. However, the five randomised controlled trials which have compared tamoxifen vs surgery have demonstrated better local control with surgery than with tamoxifen (Robertson et al, 1992;Gazet et al, 1994;Bates et al, 2001;Fentiman et al, 2003;Mustacchi et al, 2003). However, only one of these studies showed a reduction in survival with tamoxifen after 12 years of follow-up (Bates et al, 2001).…”

Section: Primary Endocrine Therapymentioning

confidence: 99%

Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines

et al. 2004

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Breast cancer-specific mortality is static in older women despite having fallen in younger age groups, possibly due to lack of screening and differences in treatment. This study compared stage and treatment between two cohorts of postmenopausal women (55 -69 vs 470 years) in a single cancer network over 6 months. A total of 378 patients were studied (470: N ¼ 167, 55 -69 years: N ¼ 210). Older women presented with more advanced disease (470: metastatic/locally advanced 12%, 55 -69 years: 3%, Po0.01). Those with operable cancer had a worse prognosis (Nottingham Prognostic Index (NPI) 470: median NPI 4.4, 55 -69 years: 4.25, Po0.03). These stage differences were partially explained by higher screening rates in the younger cohort. Primary endocrine therapy was used in 42% of older patients compared with 3% in the younger group (Po0.001). Older women with cancers suitable for breast conservation were more likely to choose mastectomy (470: 57.5% mastectomy rate vs 55 -69 years: 20.6%, Po0.01). Nodal surgery was less frequent in older patients (470: 6.7% no nodal surgery, 55 -69 years: 0.5%, Po0.01) and was more likely to be inadequate (470: 10.7% o4 nodes excised, 55 -69 years: 3.4%, Po0.02). In summary, older women presented with more advanced breast cancer, than younger postmenopausal women and were treated less comprehensively.

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Section: Primary Endocrine Therapymentioning

confidence: 99%

Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines

et al. 2004

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“…A series of randomised trials compared tamoxifen alone versus surgery alone [15][16][17] and a recent meta-analysis comparing surgery with primary endocrine therapy for operable breast cancer in elderly women found no difference in overall survival [18]. Several randomised trials compared tamoxifen alone with surgery followed by tamoxifen and in all but one of these trials there was a significant increase in local events in the tamoxifen alone group [19][20][21][22][23]. One study also showed a significantly higher mortality in patients treated by tamoxifen alone but this increase in mortality was only apparent after 3 years of follow up [11].…”

Section: Discussionmentioning

confidence: 99%

Increase in response rate by prolonged treatment with neoadjuvant letrozole

Dixon

Renshaw

Macaskill

et al. 2008

Breast Cancer Res Treat

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Purpose The aim of this study was to investigate the potential benefits of prolonged treatment with neoadjuvant letrozole. Patients and Methods About 182 consecutive patients have been treated in Edinburgh with neoadjuvant letrozole for 3 months or longer and 63 patients have continued on letrozole beyond 3 months. Outcomes are reported. Results Of the 63 patients who continued on letrozole, 38 patients took letrozole for more than 1 year and 23 took letrozole for more than 24 months. The median reduction in clinical volume in the first 3 months in these 63 patients was 52%. Similar reductions in median clinical volume were seen between three to 6 months (50%), 6-12 months and 12-24 months (medians 37 and 33%, respectively). At 3 months 69.8% of the 182 patients had a partial or complete response. The response rate increased to 83.5% with prolonged letrozole treatment. Continuing letrozole beyond 3 months increased the number of women who initially required mastectomy or had locally advanced breast cancer who were subsequently suitable for breast conserving surgery from 60% (81/134) at 3 months to 72% (96/134). Thirty-three women remain on letrozole alone (man age at diagnosis 83 years) and at 3 years the median time to treatment failure has not been reached. Conclusion Continuing letrozole in responding patients beyond 3-4 months achieves further clinical reduction in tumour size. For elderly women with a short life expectancy letrozole alone may provide long-term disease control.Keywords Breast conserving surgery Á Endocrine therapy Á Neoadjuvant Á Letrozole Á Large operable and locally advanced breast cancer

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“…Despite the large differences in progression rates, there has until recently been no evidence that mortality rates differ between these two treatments. This year, however, a trial of tamoxifen alone versus tamoxifen plus operation, with follow-up to 12 years, reported a significant reduction in survival in the tamoxifen-only group 66 . On current evidence, there is nothing to recommend the use of primary endocrine therapy for the treatment of operable breast cancer on the grounds of old age alone.…”

Section: Primary Endocrine Therapymentioning

confidence: 99%