Early-Stage Breast Cancer in the Octogenarian: Tumor Characteristics, Treatment Choices, and Clinical Outcomes

Abstract

Background Nodal staging with sentinel node biopsy (SLNB), post-lumpectomy radiotherapy (RT), and endocrine therapy (ET) for estrogen receptor-positive (ER+) tumors is valuable in the treatment of early-stage (stages 1 or 2) breast cancer but used less often for elderly women. Methods This retrospective study investigated women referred for surgical evaluation of biopsy-proven primary early-stage invasive breast cancer from January 2001 to December 2010. Clinicopathologic features, treatment course, and outcomes for women ages 80–89 years and 50–59 years were compared. Results The study identified 178 eligible women ages 80–89 years and 169 women ages 50–59 years. The elderly women more often had grade 1 or 2 disease (p = 0.003) and ER+ tumors (p = 0.007) and less frequently had undergone adjuvant therapies (all p ≤ 0.001). Lumpectomy was performed more commonly for the elderly (92 vs. 83 %, p = 0.02), and axillary surgery was less commonly performed (46 vs. 96 %; p < 0.001). Fewer elderly women had undergone post-lumpectomy RT (42 vs. 89 %; p < 0.001) and ET for ER+ tumors (72 vs. 95 %; p < 0.001). During the median follow-up period of 56 months for the 80- to 89-year old group and 98 months for the 50- to 59-year-old group, death from breast cancer was similar (4 vs. 5 %; p = 0.5). The two groups respectively experienced 7 versus 6 locoregional recurrences and 11 versus 13 distant recurrences. Conclusions The octogenarians had disease survivorship similar to that of the younger women despite less frequent use of adjuvant therapies, likely reflecting lower-risk disease features. Whether increased use of axillary surgery, post-lumpectomy RT, and/or ET for ER+ tumors would further improve outcomes is an important area for further study, but treatment should not be deferred solely on the basis of age.

Treatment Strategies in Octogenarians with Early-Stage, High-Risk Breast Cancer

“…4 It also is likely that providers underestimate life expectancy, with recent U.S. data indicating that an 80-year-old woman is expected to live a median of 8.6 years, with a wide interquartile range (4.6–13 years). 6 This study provides insight into a growing population that is underrepresented in most clinical trials, with data being even further limited among the small minority of elderly women with high-risk disease biology.…”

“…These findings corroborate previous observations that nodal surgery is frequently omitted in elderly patients. 4 This may result in decreased regional control and potential withholding of adjuvant therapies in patients who might benefit from them if they were known to have axillary nodal involvement.…”

“…4 We conducted a retrospective cohort study of women ages 80–89 years who were referred for surgical evaluation of biopsy-proven early stage (stage I or II) invasive breast cancer from January 2001 to December 2010. We excluded women with incomplete medical records, those who received neoadjuvant therapy, those presenting with bilateral breast cancers, and those with a personal history of breast cancer.…”

“…2–5 This phenomenon likely accounts for the non-inferior disease survivorship that has been observed among octogenarians, despite less frequent use of standard adjuvant therapies. 4 …”

Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

“…Finally, decision-making in elderly patients are driven by additional considerations such as life expectancy, comorbidities (45,46), functional status, biologic aggressiveness of disease (47–48), benefits of palliation, availability of alternatives, and access to treatments are all important considerations in treatment choice (12,49,50), as well as patient preference, including decisions favoring less than curative treatment.…”