Ten-Year outcomes for elderly women treated with breast-conserving surgery and definitive breast irradiation for early stage breast cancer.

Reviewer: Tracy d'Entremont, MD
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Last Modified: June 1, 2003

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Presenter: Sandra L. Urtishak
Presenter's Affiliation: Hospital of the University of Pennsylvania
Type of Session: Poster

Background

  • Breast cancer is a major cause of morbidity and mortality among elderly women, but it is not well studied in this population.
  • Older women are more often under treated by conventional criteria when compared with younger women with the same stage disease.
  • Rationalization for this undertreatment often blames the increased frequency of co-morbidities which may complicate the therapy as well as the belief that breast cancer in the elderly is a more indolent disease.
  • This study was undertaken in order to define the outcomes and toxicities of commonly recommended therapies in this elderly patient population.

Materials and Methods

  • This is a retrospective analysis of 164 women over the age of 70 with stage I or II breast cancer who underwent breast conserving therapy between the years of 1977 and 1995 at the Hospital of the University of Pennsylvania.
  • The median age was 75 years.
  • The distribution of ages were as follows: 48% between the ages of 70-74, 32% between the ages of 75-79, and 20% aged 80 or above.
  • 74% of the women had T1 disease and 26% had T2 disease.
  • 77% of the women underwent axillary dissection.
  • 3% received adjuvant chemotherapy
  • 34% received adjuvant hormonal therapy.

Results

    With a median of 6.6 years of follow-up:
  • 51% were alive without disease.
  • 2% were alive with disease.
  • 13% were dead from breast cancer.
  • 15% were dead from other causes.
  • 19% were dead of unknown causes.

Author's Conclusions

  • Breast conserving surgery and definitive breast irradiation provide good outcomes in appropriately selected elderly women.
  • Old age itself should not be a contraindication to breast conserving therapy.

Clinical/Scientific Implications

    This is yet another study which reminds us as clinicians that we should not practice ageism. Time and time again studies have demonstrated that age alone does not predict efficacy or toxicity of various oncologic treatments, including chemotherapy and now radiation therapy. It may be true that elderly women have hurdles to receiving breast conserving therapy such as lack of access to daily radiation treatments. But each case should be reviewed individually and appropriate therapy should be offered to all women regardless of age.

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