Abstract P5-14-06: Relationship between Surgery and Survival in Elderly Breast Cancer Patients over 75 Years of Age

Abstract

Abstract Background: There is an increasing interest in the reporting of breast cancer characteristics, treatment and survival in the elderly age group (>75). Studies suggest that elderly women receive less aggressive treatment, experience higher disease progression and mortality from breast cancer. We report on a single institutional experience of 256 consecutive cases of symptomatic breast cancer in a population of over 75 years of age. Methods: We undertook a retrospective review of 256 consecutive cases of breast cancer in patients over the age of 75 treated at the Sunderland Royal Hospital between August 1998 and August 2005. Therapeutic/surgical decision was a joint affair involving our multidisciplinary team, the patient and her family. Patient demographic data, tumour biology data, therapeutic data and outcome data were recorded. Statistical analysis was performed by the Newcastle Industrial Statistics Unit. Results: 142/256 patients underwent surgical intervention, 114/256 did not. Mean follow up was 6.4 years. The findings as well and their statistical significance are illustrated below: Physiological reserve, treatment and outcomes Table 1 Our results show a weak but statistically significant association between surgery and survival (p=0.05, CI 0.00046 - 0.19641) and a strong statistically significant association between surgery and disease progression/recurrence (p=0.001, CI 0.08713 - 0.03145). The morbidity of our surgical group is low. We experienced one postoperative death. Discussion: We are cautious in affirming that our elderly group suffers from under treatment. There may be reasons for the observed pattern. Apart from a discrepancy in our axillary staging procedures (15/142), all suitable patients received adjuvant radiotherapy. Adjuvant chemotherapy was omitted in most cases, however this may be the result of multidisciplinary decisions guided by AdjuvantOnline calculations and patient's wishes. Women in the group treated conservatively are significantly less fit hence suffering high cancer unrelated mortality. As a consequence of their unfitstate the elderly group (treated conservatively) suffers higher disease related progression and mortality. Overall, in our retrospective study surgical treatment with adjuvant endocrine and/or radiotherapy was associated with a statistically significant advantage in terms of disease related mortality and local disease control. We suggest that treatment pathways should be guided by physiological reserve and geriatric assessment tools rather than age alone. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-06.