Long-term clinical outcome of oestrogen receptor-positive operable primary breast cancer in older women: a large series from a single centre

Abstract

Introduction:A Cochrane review of seven randomised trials (N=1571) comparing surgery and primary endocrine therapy (PET) (oestrogen receptor (ER) unselected) shows no difference in overall survival (OS). We report outcome of a large series with ER-positive (ER+) early invasive primary breast cancer.Methods:Between 1973 and 2009, 1065 older (⩾70 years) women (median age 78 years (70–99)) had either surgery (N=449) or PET (N=616) as initial treatment.Results:At 49-month median follow-up (longest 230 months), the 5-year breast cancer-specific survival (BCSS) and OS were 90 and 62%, respectively. Majority (74.2%) died from causes other than breast cancer. The rates (per annum) of local/regional recurrence (<1%) (following surgery), contralateral tumour (<1%) and metastases (<3%) were low. For patients on PET, 97.9% achieved clinical benefit (CB) at 6 months, with median time to progression of 49 months (longest 132 months) and significantly longer BCSS when compared with those who progressed (P<0.001). All patients with strongly ER+ (H-score >250) tumours achieved CB and had better BCSS (P<0.01). Patients with tumours having an H-score >250 were found to have equivalent BCSS regardless of treatment (surgery or PET; P=0.175), whereas for those with H-score ⩽250, surgery produced better outcome (P<0.001).Conclusion:Older women with ER+ breast cancer appear to have excellent long-term outcome regardless of initial treatment. Majority also die from non-breast cancer causes. Although surgery remains the treatment of choice, patients with ER-rich (H-score >250) tumours tend to do equally well when treated by PET. This should be taken into account when therapies are considered.

Biological Characteristics and Clinical Outcome of Triple Negative Primary Breast Cancer in Older Women – Comparison with Their Younger Counterparts

“…The overall outcome of the two age groups with TNBCs was poor with a 5-year breast cancer survival of 73% and 79% in <70 and ≥70 years age groups respectively, which is in keeping with the literature [30], as compared to that reported by us (5-year breast cancer survival being 91% and 90% respectively for the whole series of older women and in the ER positive subgroup) [12], [20]. However, despite the fact that they did not receive any adjuvant chemotherapy, the older women did not do any worse than their younger counterparts.…”

A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer

“…8 This survey confirms that AIs have also mostly replaced tamoxifen in the PET setup. Few papers confirming the efficacy of AIs as PET have been published [9][10][11] and AIs have not been compared with surgery in a prospective randomised fashion. One trial that attempted to do this closed early owing to poor recruitment.…”

“…A large retrospective study of 616 PET patients, in which tamoxifen was used for the majority (69%) but an AI was used for others, with a median follow-up duration of 41 months, reported tumour progression in 45% of patients with a median time to progression of 49 months. 10 In another study of 101 patients treated with letrozole, with a median follow-up duration of 56 months, 18% of patients with hormone receptor positive tumours did not respond and another 18% responded initially but later progressed. 11 This makes PET even with an AI decidedly inferior to surgery in terms of local control.…”

Hormone Treatment without Surgery for Patients Aged 75 Years or Older with Operable Breast Cancer

“…19 Not only in the south of the Netherlands but also in other parts of Europe, a substantial number of elderly women with breast cancer are receiving PET. 5,20 Wyld et al reported 40% of the women C70 years were receiving PET for breast cancer in the UK in 2002. 5 We found large differences between hospitals in the percentage of elderly breast cancer patients treated with PET in the south of the Netherlands, indicating that there is a lack of consensus between physicians with respect to its use.…”