title: Breast cancer in the very elderly: treatment patterns and complications in a tertiary cancer center.
abstract: BACKGROUND
  The risk of developing breast cancer rises with increasing age. The very elderly population (80 years of age and greater) is often excluded from both clinical trials and retrospective analyses. We performed a retrospective review of the very elderly population treated at our institution in order to assess treatment patterns and the safety of therapy in an older population.
  
  
  METHODS
  In this institutional experience at a comprehensive cancer center, we retrospectively reviewed the charts of patients 80 years and older diagnosed with a new breast cancer between September 1, 1989, and September 1, 2004.
  
  
  RESULTS
  Two hundred thirteen patients were identified for this study. Median age was 83 (range 80-97). Median survival was 7.28 years, with a median follow up of 4 years for patients still alive at the end of the study period. Ninety-eight percent of patients (208/213) received 1 or more components of recommended multimodality treatment. Five patients refused all treatment. Overall, complications affected 12% of patients who received treatment (26/208). There were 2 deaths, 1 after surgery and 1 related to chemotherapy. The majority, 69% (18/26), of the documented complications were classified as minor. Surgery resulted in complications in 6% (11/188) of patients. Five percent (5/112) of patients who received radiation suffered adverse effects. Chemotherapy-related complications affected 30% (6/18) of treated patients. Hormonal agents resulted in complications in 3% (3/112) of patients. No correlation between the American Society of Anesthesiologists score and incidence of complication was observed (P = .58).
  
  
  CONCLUSIONS
  Very elderly patients can be safely treated with surgery and radiation in accordance with accepted recommendations for their stage of breast cancer. Treatment with surgery and/or radiation should be considered despite age and moderate comorbidity in order to affect locoregional control. Chemotherapy results in a significant incidence of complications and should be cautiously implemented in this age group. A prospective trial is necessary to assess the necessity of aggressive multimodality therapy in this very elderly population.
authors.affiliation: MD Anderson Cancer Center, Department of Surgical Oncology, 1515 Holcombe Blvd, Houston, TX 77030, USA. kmr4444@gmail.com
authors.forename: Kari M
authors.initials: KM
authors.lastname: Rosenkranz
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Kari
authors.initials: K
authors.lastname: Hartman
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: E Sonja
authors.initials: ES
authors.lastname: Singletary
authors.forename: Rosa
authors.initials: R
authors.lastname: Hwang
authors.forename: Barry
authors.initials: B
authors.lastname: Feig
authors.forename: Merrick
authors.initials: M
authors.lastname: Ross
authors.forename: Frederick
authors.initials: F
authors.lastname: Ames
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
mesh_terms: D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D020847:Estrogen Receptor Modulators / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D020847:Estrogen Receptor Modulators