Breast Cancer Survival of Elderly Women in the Netherlands (1994-2005).

Abstract

Abstract Purpose of the study: Breast cancer is the most commonly diagnosed malignancy in elderly women. With an increasing life expectancy of Western populations and increasing incidence of breast cancer, it is one of the major health concerns in the geriatric population. Aim of this study was to assess time trends in relative survival of elderly breast cancer patients in the Netherlands as compared to the younger patients and compare expected and observed mortality in the Dutch population.Methods: Female breast cancer patients 15 years and older, diagnosed with their first primary breast cancer from 1994-2005, were selected from the Netherlands Cancer Registry (NCR). Relative survival was calculated by the Hakulinen method as the ratio of the survival observed among the cancer patients and the survival that would have been expected based on the corresponding (age and year) general population. National life tables were used to estimate expected survival. Relative Excess Risks of death (RER) over time according to age were estimated using a multivariate generalized linear model with a Poisson distribution, based on collapsed relative survival data, using exact survival times.Results: Overall, 127 805 patients were included. Relative survival (5-years) declined from 87.1% for 15-65 years old to 86.1% (65-74), 74.7% (75-84) and 68.4% for 85 years and older. From 1995-2005 relative survival did increase for the young patients (RER corrected for stage, histology, treatment and grade 0.93; p<0.001) and for 65-69 (RER 0.93; p<0.001), 70-74 (RER 0.97; p=0.005) and 75-79 (0.98; p=0.03) years old. However, relative survival did not increase significantly for elderly patients of 80 years and older. Relative survival was higher for patients younger than 70 years and the difference in (corrected) RER for elderly versus young patients did increase over the years from 1.22 to 1.69 (p<0.001). Stratified for stage the differences were most striking in the higher stages. Differences between observed and expected mortality decreased with increasing age.Conclusion(s): The gap in breast cancer survival between young and elderly (>70) patients has increased in the Netherlands and survival for patients of 80 years and older has not improved. Despite growing degree of interest, internationally agreed evidence-based guidelines for the elderly with breast cancer do not exist. The aim of the FOCUS study that recently started in the Netherlands is to develop clinical guidelines for the elderly females with breast cancer using population-based, clinical trial and molecular data. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2052.