Breast Cancer in the Elderly: Treatment of 1500 Patients

Abstract

There is a significant difference in the extent of treatment offered to the elderly with breast cancer; in the United States, while 98% of patients less than 65 years of age receive standard treatment, 81% of those older than 65 years were treated according to protocol. This study's goal was to evaluate disease-specific survival and local-regional recurrence in breast cancer patients more than 65 years of age at diagnosis. A total of 1500 patients with invasive breast carcinoma were treated consecutively from May 1971 to July 2002 at the University of Florence, Florence, Italy. All patients were more than 65 years of age. The median age was 70.6 years (range 65.1-87.3 years). The median follow-up was 8.7 years (range 1-30 years). The crude probability of survival (or relapse occurrence) was estimated using the Kaplan-Meier method and survival (or relapse occurrence) comparisons were carried out using Cox proportional hazard regression models. The Cox regression model by stepwise selection showed as independent prognostic factors for disease-specific survival (DSS), the occurrence of a local relapse (p < 0.0001), pN status (p < 0.0001), the type of surgery (p < 0.0001), and the use of radiotherapy (p < 0.0006) and chemotherapy (p = 0.01). For local disease-free survival (LDFS), the Cox regression model by stepwise selection showed that mastectomy (p < 0.0001), histotype (p < 0.0001), pN status (p < 0.0001), and pT status (p = 0.001) were the only independent prognostic factors. Age was not a prognostic factor for DSS nor LDFS. We suggest treating patients with appropriate treatment for their prognostic factors.

Prognostic factors in elderly patients with breast cancer

“…It is important to warrant older women the same treatments offered to younger women, unless unworthy for limited life-expectancy, to avoid that age becomes not only a risk factor for BC, but even a poor prognostic factor [78]. …”

“…The reduced expectancy of life due to the age and to other diseases often induces both physicians and patients to choose less aggressive therapies, so older women undergo to not-standard treatments more often than the younger ones [20,78-81]. …”

Health profiles of older women cancer survivors

“…Kreling et al [4] also reported that older breast cancer patients tend to receive much less chemotherapy. Another study found that 81% of breast cancer patients 65 years and older were treated according to established protocol while 98% of patients younger than 65 years received standard treatment [5].…”

Clinicopathological features and treatment sensitivity of elderly Chinese breast cancer patients

“…However, these patients exhibited a lower RFS and OS. It is likely that elderly patients were less sensitive to chemotherapy, and, as Livi et al reported, chemotherapy was correlated with a lower survival rate (36). Nevertheless, this result may be due to the fact that only patients with worse prognostic factors received chemotherapy and that the majority of elderly patients in our study received CMF or anthracycline-based chemotherapy, which had a low effect and high cardiac toxicity (37,38).…”