Elderly Breast Cancer Patients Benefit from Surgery According to Guidelines

Abstract

Purpose To investigate among women ≥ 70 years with early stage invasive breast cancer, whether primary endocrine therapy and omission of surgery resulted in an inferior relative survival, whether the omission of preoperative imaging resulted in an inferior local control, and whether the omission of axillary staging resulted in an inferior regional control and inferior relative survival. Methods A single center retrospective cohort study at Herlev Hospital, Denmark. Relative survival was expressed as standardized mortality ratios (SMR) and differences were estimated using Poisson regression and evaluated by rate ratios (RR). Differences in local and in regional recurrence were estimated by a Cause Specific Hazard Model and evaluated by hazard ratios (HR). Models were adjusted for age, comorbidity, and tumor size. Results We identified 1,142 women. Patients who received only endocrine therapy had a higher SMR than patients treated with primary surgery (RR = 2.57;95%CI:2.01–3.30). Patients treated with primary breast conserving surgery (BCS) did not have a lower risk of local recurrence if they received preoperative imaging (HR = 0.88;95%CI:0.27–2.81). Finally, patients who received an axillary staging had a lower risk of regional recurrence compared to patients who did not receive axillary surgery (HR = 0.25;95%CI:0.08–0.84), but not a statistically significant superior relative survival (RR = 0.78;95%CI:0.60-1.00). Conclusion Elderly women with early stage breast cancer treated with only endocrine therapy had an inferior relative survival, omission of axillary staging resulted in a higher risk of regional recurrence and a tendency to an inferior relative survival, and omission of preoperative imaging before BCS did not result in a higher risk of local recurrence.