Abstract
BackgroundThe majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making.MethodsA questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013. This detailed surgical options and recommendations, timing of decision making, treatment expectations, psychological and cosmetic concerns and other factors which may have influenced any decision made e.g. travel for radiotherapy and potential side effects.ResultsResponses were received from 339 patients, 192 of whom had a mastectomy with the remaining undergoing BCS. In the mastectomy group 18 % (35) would have preferred to have BCS had it been an option, with 40 % (76) of group being happy to take neoadjuvant endocrine therapy to try and facilitate this. However, only 14 % (26) of patients would have considered neoadjuvant chemotherapy with the same aim. Almost half (82) of the mastectomy patients said that the risk of local recurrence following BCS was a factor which influenced their decision.ConclusionBCS is something that patients aged over 70 are interested in considering in the same way as younger patients. More than a third of patients requiring mastectomy would be willing to take neoadjuvant endocrine therapy to attempt to downstage their tumour to facilitate BCS.
Highlights
The majority of breast conserving surgery (BCS) is performed in younger women
Patients differ in a number of important respects from younger women and these may affect the outcome of their breast cancer treatment
Responses were received from 339 patients (64 %) and, of these, 192 patients had a mastectomy (57 %) and 145 had BCS performed (43 %)
Summary
The majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. Patients differ in a number of important respects from younger women and these may affect the outcome of their breast cancer treatment They have increased co-morbidities in addition to different psychological and functional profiles (physical capabilities and activities of daily living; Yancik et al 2001). These recommendations tend to be based on extrapolated results from younger patients, or small retrospective sub-group analysis due to lack of level 1 evidence in the older population as historically they have been excluded from randomised controlled trials (Biganzoli et al 2012) This is despite studies demonstrating that the elderly are willing to participate in breast conservation trials (Silliman et al 1993)
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