title: Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients.
abstract: Breast cancer is the most common type of cancer in several parts of the world and the number of elderly patients is increasing. The aim of this study was to describe stage at diagnosis, treatment, and relative survival of elderly patients compared to younger patients in the Netherlands. Adult female patients with their first primary breast cancer diagnosed between 1995 and 2005 were selected. Stage, treatment, and relative survival were described for young and elderly (≥ 65 years) patients and within the cohort of elderly patients according to 5-year age groups. Overall, 127,805 patients were included. Elderly breast cancer patients were diagnosed with a higher stage of disease. Moreover, within the elderly differences in stage were observed. Elderly underwent less surgery (99.2-41.2%); elderly received hormonal treatment as monotherapy more frequently (0.8-47.3%); and less adjuvant systemic treatment (79-53%). Elderly breast cancer patients with breast cancer had a decreased relative survival. Although relative survival was lower in the elderly, the percentage of patients who die of their breast cancer less than 50% above age 75. In conclusion, the relative survival for the elderly is lower as compared to their younger counterparts while the percentage of deaths due to other causes increases with age. This could indicate that the patient selection is poor and fit patients could suffer from "under treatment". In the future, specific geriatric screening tools are necessary to identify fit elderly patients who could receive more "aggressive" treatment while best supportive care should be given to frail elderly patients.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, RC, The Netherlands. e.bastiaannet@lumc.nl
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: G J
authors.initials: GJ
authors.lastname: Liefers
authors.forename: A J M
authors.initials: AJ
authors.lastname: de Craen
authors.forename: P J K
authors.initials: PJ
authors.lastname: Kuppen
authors.forename: W
authors.initials: W
authors.lastname: van de Water
authors.forename: J E A
authors.initials: JE
authors.lastname: Portielje
authors.forename: L G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: M L G
authors.initials: ML
authors.lastname: Janssen-Heijnen
authors.forename: O M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: R G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D016014:Linear Models; D008197:Lymph Node Excision; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal