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

Abstract

Purpose: Breast cancer is known to disproportionately affect older women. As the population continues to age, the number of elderly women with invasive cancer will continue to increase, particularly among female octogenarians who comprise the fastest segment of the United States population. Despite this, data to guide treatment of patients in this age group are lacking as they are consistently underrepresented in clinical trials. In all practice settings, the literature indicates that older women with breast cancer are undertreated, with a corresponding increase in mortality. Methods: We conducted a retrospective cohort study of women ages 80–89 years and 50–59 years who were referred for surgical evaluation of biopsy-proven primary early-stage invasive breast cancer from January 2001 to December 2010 at our institution. Clinical and pathologic disease characteristics, comorbidities, therapies recommended and received, and outcomes for women ages 80–89 years and 50–59 years were abstracted from the medical record and 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 B 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.