Age, comorbidity, and breast cancer severity: impact on receipt of definitive local therapy and rate of recurrence among older women with early-stage breast cancer.
BACKGROUND
The definitive local therapy options for early-stage breast cancer are mastectomy and breast-conserving surgery followed by radiation therapy. Older women and those with comorbidities frequently receive breast-conserving surgery alone. The interaction of age and comorbidity with breast cancer severity and their impact on receipt of definitive therapy have not been well-studied.


METHODS
In a cohort of 1,837 women aged 65 years and older receiving treatment for early-stage breast cancer in 6 integrated health care delivery systems in 1990-1994 and followed for 10 years, we examined predictors of receiving nondefinitive local therapy and assessed the impact on breast cancer recurrence within levels of severity, defined as level of risk for recurrence.


RESULTS
Age and comorbidity were associated with receipt of nondefinitive therapy. Compared with those at low risk, women at the highest risk were less likely to receive nondefinitive therapy (odds ratio = 0.32; 95% CI, 0.22-0.47), and women at moderate risk were about half as likely (odds ratio = 0.54; 95% CI, 0.35-0.84). Nondefinitive local therapy was associated with higher rates of recurrence among women at moderate (hazard ratio = 5.1; 95% CI, 1.9-13.5) and low risk (hazard ratio = 3.2; 95% CI, 1.1-8.9). The association among women at high risk was weak (hazard ratio = 1.3; 95% CI, 0.75-2.1).


CONCLUSIONS
Among these older women with early-stage breast cancer, decisions about therapy partially balanced breast cancer severity against age and comorbidity. However, even among women at low risk, omitting definitive local therapy was associated with increased recurrence.
Meyers Primary Care Institute, Worcester, MA 01605, USA. Terry.Field@umassmed.edu
Terry S
TS
Field
Jaclyn L F
JL
Bosco
Marianne N
MN
Prout
Heather T
HT
Gold
Sarah
S
Cutrona
Pamala A
PA
Pawloski
Marianne
M
Ulcickas Yood
Virginia P
VP
Quinn
Soe Soe
SS
Thwin
Rebecca A
RA
Silliman
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008408:Mastectomy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D016896:Treatment Outcome