title: Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach.
abstract: OBJECTIVE
  The current work assessed the independent contributions of age, comorbidities, tumor features, and treatment approach to the outcome of elderly patients with breast cancer.
  
  
  METHODS
  Records of consecutive women aged > or = 70 years with a histologic diagnosis of first invasive breast cancer between 1971 and 2001 and available medical information were reviewed. Restaging to the 2002 TNM system and comorbidity data abstraction were performed. Primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS).
  
  
  RESULTS
  There were 992 patients with a median diagnosis age of 76 years, of whom 840 were approached with a curative intent. Significant comorbidities were recorded as none and > or = 3 in 13% and 44% of patients, respectively. The 5- and 10-year OS rates were 59% and 34%; corresponding BCSS rates were 74% and 62%, respectively. Of 693 patients who died during the study period, only 298 (43%) died from their tumors. Stage emerged as the strongest predictor determining OS and BCSS (P = 0.001). In curatively approached patients, age was the next dominant factor affecting survival length (P = 0.001). The comorbidities with significant effect on OS differed by stage and included heart failure, diabetes, and other common comorbidities in early tumors but only extremely debilitating ones in advanced-stage disease (P < 0.05). Significant favorable effect of systemic therapy emerged only in the univariate model.
  
  
  CONCLUSIONS
  This study confirms tumor stage as the strongest predictor of survival in elderly patients with breast cancer. It also indicates a significant role for age and comorbidities that varies by stage. Treatment effect should be interpreted with caution because of the retrospective study nature.
authors.affiliation: Department of Hematology and Oncology, Geisinger Medical Center, Danville, PA, USA. nsd@seagal.us
authors.forename: Nava
authors.initials: N
authors.lastname: Siegelmann-Danieli
authors.forename: Vivek
authors.initials: V
authors.lastname: Khandelwal
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Roshan
authors.initials: R
authors.lastname: Mainali
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Prichard
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Murphy
authors.forename: James F
authors.initials: JF
authors.lastname: Evans
authors.forename: Omar
authors.initials: O
authors.lastname: Yumen
authors.forename: Albert M
authors.initials: AM
authors.lastname: Bernath
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome