Assessment of surgical treatment in elderly patients with breast cancer.
OBJECTIVE
The incidence of breast cancer increases with advancing age and in clinical practice approximately 50% of new cases occur in women over the age of 65 years. Although breast cancer in elderly patients presents more favorable biological characteristics than similar-stage cancer in younger women, disease control still remains uncertain and is becoming a major health problem.


METHODS
Between 1984 and 2006, 133 patients aged over 65 with operable breast cancer underwent surgical treatment. Patients with ductal or lobular carcinoma in situ, bilateral breast cancer or a previous malignancy were excluded. The mean age was 72.8 years (range, 66-89). Breast-conserving surgery was performed in patients with early breast cancer (T1, T2 < 2.5 cm), while most patients with advanced tumors (T2 >2.5 cm, T3, T4) were treated by modified radical mastectomy.


RESULTS
The pathological stage was I in 44, IIA in 54, IIB in 18, IIIA in 10 and IIIB in 7 patients. Postoperative complications occurred in 13 patients (9%); there were no postoperative deaths. Eighty-nine patients underwent adjuvant therapy (chemotherapy, hormonal therapy). After a median follow-up of 96 months (range, 5-266), disease progression was observed in 21 patients (15.8%). The overall mortality from breast cancer was 11%, whereas the cancer-unrelated mortality was 9%.


CONCLUSIONS
There is no evidence that breast cancer has a more favorable prognosis in the elderly and surgical procedures should be carried out as has been established in younger women. At present, elderly patients are much less likely to be entered into randomized clinical trials and are often undertreated. However, in the absence of serious comorbid disease, they are able to withstand standard multimodal treatment options as well as do younger patients.
De Cesare
Alessandro
A
Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy. alessandro.decesare@tin.it
Burza
Antonio
A
Fiori
Enrico
E
Bononi
Marco
M
Volpino
Patrizia
P
Leone
Giovanni
G
Crocetti
Alessandro
A
Cangemi
Vincenzo
V
D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D018275:Carcinoma, Lobular / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods; D009367:Neoplasm Staging; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone