Elderly women with breast cancer often die due to other causes regardless of primary endocrine therapy or primary surgical therapy

Abstract

Survival and cause of death was investigated for Primary Surgical Therapy (PST) and Primary Endocrine Therapy (PET). Of women aged ≥75 years 113 patients received PET, 233 patients underwent PST. PST gave better survival, although this group was younger (p < 0.001). During follow-up the percentage of deaths due to breast cancer was similar and stable in both groups. Increased age was associated with a higher risk on death due to other causes (HR 1.11; CI 1.07-1.14), not on death due to breast cancer (HR 0.94; CI 0.87-1.01). The association of type of treatment and death due to breast cancer was not different between both groups in univariate analyses (HR 0.78; CI 0.44-1.39). In the multivariate model this non-significance remained after correcting for tumor size and age (HR 0.68; CI 0.33-1.42). Treatment should not be based merely on surgical treatment. PET may be an acceptable alternative.

Predicting disease-related and patient-reported outcomes in older patients with breast cancer - a systematic review

“…Moreover, these patients are more likely to experience toxicity of treatment and decline in quality of life or function due to treatment. In this review, we found only four studies that investigated predictors for other cause mortality, which shows that this subject is still understudied despite the clinical relevance [25][26][27][28].…”

Early operable breast cancer in elderly women treated with an aromatase inhibitor letrozole as sole therapy

“…Breast cancer is common in the elderly (Lilienfeld, 1963; Louwman et al , 2008; NHS_Cancer_Screening_Programmes); 31% of the 50 286 cancers diagnosed in the UK in 2007 were in those aged 70 years or over (Traa et al , 2011). A significant proportion of very elderly women are either unfit or unwilling to undergo standard therapy, despite the low morbidity associated with breast cancer surgery.…”

“…Primary endocrine therapy (PET), where the cancer is treated solely with an endocrine agent, is an option in women with an ER/PR-positive tumour who are unsuitable or unwilling to undergo surgery (Milla-Santos et al , 2004; Crivellari et al , 2008; Muss et al , 2008). Twenty-six percent of women aged 70–79 years and 61% of women aged 80 years and above diagnosed with breast cancer in the UK have no surgical treatment recorded and it is likely that most of these patients are treated with PET (Traa et al , 2011). Tamoxifen has been the PET drug of choice for a number of years (Crivellari et al , 2008).…”

Primary endocrine therapy as a treatment for older women with operable breast cancer – A comparison of randomised controlled trial and cohort study findings

“…Several recent studies have found that up to 40% of patients over 70 years old are treated with PET in the UK [11,12]. Additionally, there have been several new studies published within the last two years looking at cohorts of women treated using PET [13][14][15][16][17][18][19][20][21][22]. The methodology of these cohort studies vary greatly, particularly in terms of the treatment used, the fitness of included patients and whether ER testing was performed, again limiting the overall applicability to modern clinical practice.…”