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Treatment of breast cancer in the elderly : a prospective, population-based Swiss study
Journal
Journal of geriatric oncology
Volume
4
Number
1
Pages / Article-Number
39-47
Keywords
Breast cancer, Elderly, Radiotherapy, Sentinel lymph node biopsy, Chemotherapy
Abstract
Objectives: The primary objective of this population-based study is to describe the patterns of care of elderly patients with breast cancer (BC), and evaluate potential causative factors for the decrease in BC-specific survival (BCSS) in the elderly.Patients and Methods: We included all or representative samples of patients with newly diagnosed BC from seven Swiss cancer-registries between 2003 and 2005 (n=4820). Surgical and non-surgical BC treatment was analyzed over 5 age groups (<65, 65 to <70, 70 to <75, 75 to <80 and >= 80 years), and the predictive impact of patient age on specific treatments was calculated using multivariate logistic regression analysis.Results: The proportion of locally advanced, metastatic and incompletely staged BC increased with age. The odds ratio for performing breast-conserving surgery (BCS) in stages I-II BC (0.37), sentinel lymph node dissection (SLND) in patients with no palpable adenopathy (0.58), post-BCS radiotherapy (0.04) and adjuvant endocrine treatment (0.23) were all in disfavor of patients >= 80 years of age compared to their younger peers. Only 36% of patients >= 80 years of age with no palpable adenopathy underwent SLND. In the adjusted model, higher age was a significant risk factor for omitting post-BCS radiotherapy, SLND and adjuvant endocrine treatment.Conclusions: This study found an increase in incomplete diagnostic assessment, and a substantial underuse of BCS, post-BCS radiotherapy, SLND and adjuvant endocrine treatment in elderly patients with BC. There is a need for improved management of early BC in the elderly even in a system with universal access to health care services. (C) 2012 Elsevier Ltd. All rights reserved.
