Abstract
AimsThe effect of undertreatment with adjuvant hormonal therapy, chemotherapy or radiation was studied in elderly women with breast cancer.MethodsA prospectively maintained database was used to identify women undergoing potentially curative surgery between 1997 and 2011. The presentation, pathologic findings, treatment and outcomes of 449 women over 65 were compared to the findings in 1049 younger patients. Moreover, conventionally treated and undertreated elderly patients were identified and their characteristics and outcomes were compared.ResultsBoth young and old patients presented most frequently with mammographic findings, but older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Cancers of older patients were signicantly more favorable than cancers in younger patients with more infiltrating lobular, fewer ductal carcinoma in situ and more frequently estrogen receptor positive and fewer were poorly differentiated. Elderly patients had less axillary surgery, less adjuvant radiation therapy and more hormonal therapy. Fourty-six percent of the 449 elderly patients were undertreated by conventional criteria. Undertreated patients were more frequently in situ, better differentiated, smaller, and more often estrogen receptor positive. Forty-four percent of the undertreated patients died during follow-up without disease recurrence.ConclusionsDespite undertreatment, local and distant disease-free survival was comparable to patients who were not undertreated.
Highlights
C We reviewed our breast cancer database with the folI low-up of patients who have been cared at General and Geriatric Surgery Department of University of Naples
97% of the 776 young patients treated with breast conservation received radiation therapy compared to 53% of the 125 elderly patients treated with breast conservation (p < 0.001)
Among patients with invasive cancers, 18% of the young patients received neoadjuvant chemotherapy and 35% adjuvant chemotherapy compared to 3% and 8% of the comparable elderly patients (p < 0.001)
Summary
Women 65 years of age and older at the time of diagnosis (449) were identified and compared to women younger than 65 years of. T radiation therapy in patients treated with breast conserving surgery; (3) lack of hormonal treatment in estrogen. Older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Both the elderly and the younger patients were most commonly diagnosed by fine-needle aspiration followed by core needle biopsy and excisional biopsy. Sentinel node excision or axillary dissection was more frequent in younger patients Adjuvant therapy with both radiation and chemotherapy was significantly less frequent in the elderly.
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