title: The effect of under-treatment of breast cancer in women 80 years of age and older.
abstract: BACKGROUND
  Several authors have demonstrated a trend toward the under-treatment of elderly and very elderly women with breast cancer. This study was undertaken to determine the impact of under-treatment of breast cancer in women age 80 and older.
  
  
  METHODS
  A retrospective chart review of all patients 80 years and older with a newly diagnosed breast cancer at the MD Anderson Cancer Center, Houston, TX, between September 1, 1989 and September 1, 2004 was performed. Data extracted from charts included patient demographics, comorbidity, treatments recommended, treatments received, complications of therapy, disease recurrence and disease related death. Treatments undertaken were analyzed in the context of accepted therapy at the time of diagnosis.
  
  
  RESULTS
  Two hundred twelve patients were identified. The median age was 83.5 years (range 80-97). Overall survival in the entire cohort was 7.28 years with a median follow up of 4 years for patients still alive at the end of the study period. Fifty seven percent of patients were under-treated according to institutional and national guidelines. Women who underwent hormonal therapy only demonstrated decreased disease specific survival (P<0.001 respectively) compared with patients who received multi-modality therapy. Women who underwent partial mastectomy without radiation treatment experienced a significant increase in local regional recurrence (P=0.045). There was an association of increased disease specific survival in patients who had surgical lymph node evaluation compared to those who did not (P=0.04).
  
  
  CONCLUSIONS
  Outcomes are compromised in very elderly women with breast cancer in whom less than complete combined modality treatment is undertaken. With the previously demonstrated safety of radiation therapy, hormonal therapy and surgery in the very elderly population, multi-modality therapy should not be routinely withheld in patients in this age category.
authors.affiliation: University Medical Center Groningen, Department of Surgery, Hanzeplein 1, Groningen, The Netherlands. b.l.van.leeuwen@chir.umcg.nl
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Van Leeuwen
authors.forename: K M
authors.initials: KM
authors.lastname: Rosenkranz
authors.forename: L Lei
authors.initials: LL
authors.lastname: Feng
authors.forename: I
authors.initials: I
authors.lastname: Bedrosian
authors.forename: K
authors.initials: K
authors.lastname: Hartmann
authors.forename: K K
authors.initials: KK
authors.lastname: Hunt
authors.forename: H M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: M
authors.initials: M
authors.lastname: Ross
authors.forename: S E
authors.initials: SE
authors.lastname: Singletary
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015999:Multivariate Analysis; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*