Treatment of early breast cancer in women over 65: what is important? Retrospective trial.

Abstract

Abstract Abstract #1125 Introduction-Background-Objective
 There are some demonstrations for the under-treatment of elderly (age 65 or older) women with early breast cancer. However, a few reports are available for overall survival as well as treatment patterns. To characterize treatment patterns and to determine the impact of under-treatment of early breast cancer in the elderly population compared to younger population.
 Methods
 We analyzed data of 4,990 early (stage I, II) breast cancer patients aged ≥ 50 years old postmenopausal women, registered in the Korean Breast Cancer Society Registration Program (KBCSRP) between 1992 and 2001 retrospectively. We compared elderly group (age 65 or older) with younger group (age 50 or older, and under age 65) in cancer stage, hormonal receptor status, p53 status, HER-2 status, breast conservation rate, radiation therapy omission rate after breast conservation surgery, chemotherapy rate, hormonal therapy rate and overall survival.
 Results
 942(19%) patients were in the elderly group and 4,048(81%) patients were in the younger group. We followed up to 2004 and median follow up period were 5.7 years. There were no differences in cancer stage, HER-2 status, and hormonal therapy rate.
 In elderly group, tumor had two better prognostic factors: more hormonal receptor positivity (63.3% vs. 59.3%; p=0.001) and less p53 positivity (37.3% vs. 49.5%: p<0.001). Overall survival, however, was lower than younger group: 83% vs. 91% in 5 year survival rate, 68% vs. 81% in 10 year survival rate, respectively. Elderly group had less breast conservation rate (16.4% vs. 20.4%; p<0.001), more radiation omission rate after breast conservation surgery (59.8% vs. 15.3%; p<0.001) and less chemotherapy rate (43% vs. 70.6%; p<0.001). Using log-rank analysis, overall survival was affected by under-treatment of disease: women who underwent breast conservation surgery without radiation therapy experienced a significant decreased survival compared to women with radiation therapy (68% vs. 84% in 10 year survival rate; p<0.001). Total mastectomy was not superior to breast conservation surgery plus radiation therapy (p=0.2856). Women who underwent chemotherapy, however, revealed no survival gains, but women with hormonal therapy showed superior survival rate (p=0.0019).
 Conclusions
 Our data revealed that elderly patients had better prognostic tumor characteristics, but lower survival rate. Deviated under-treatment patterns in elderly early breast cancer patient could be dangerous choice to patients, therefore, radiation therapy after breast conservation surgery should not be omitted and hormonal therapy should be recommended especially. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1125.