title: Omission of surgery in elderly patients with early stage breast cancer.
abstract: OBJECTIVE
  To assess national trends over time in surgery for elderly patients with resectable breast cancer (BC) and to evaluate clinical outcome and cause of death after the omission of surgery in a regional cohort of elderly patients.
  
  
  METHODS
  National trends in 1995-2005 were calculated using cancer registry data. In addition, a chart review was performed in a cohort of patients aged ≥ 75 years, with early stage BC but no primary surgery, diagnosed at five Dutch hospitals in 1990-2005. Patient characteristics, comorbidity and reason for the omission of surgery were collected from the chart. Cause of death was retrieved from death certificate data registered at Statistics Netherlands.
  
  
  RESULTS
  Omission of surgery increased significantly over time for patients aged 80 years and older (p<0.05). Of the 187 patients in the regional cohort (median age 85.9 years (range 75.0-97.7), 174 (92%) received hormonal therapy. Omission of surgery was at the patient's request in 59 patients (32%). Of the 178 patients that died during follow-up, 60 patients (34%) died of BC. For 81 patients (45%), BC was not clinically relevant at the time of death. Median overall survival was 2.3 years (range 0.2-10.7) and did not differ between BC and other causes of death (p=0.9).
  
  
  CONCLUSIONS
  Omission of surgery for elderly patients with resectable BC has increased significantly over the past decade; instead patients often received primary endocrine treatment. Although this may appear an effective alternative to surgery, the potential for a longer term negative impact on disease control and quality of life deserves further investigation.
authors.affiliation: Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands. mhamaker@diakhuis.nl
authors.forename: Marije E
authors.initials: ME
authors.lastname: Hamaker
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: Dorothea
authors.initials: D
authors.lastname: Evers
authors.forename: Willemien van de
authors.initials: Wv
authors.lastname: Water
authors.forename: Carolien H
authors.initials: CH
authors.lastname: Smorenburg
authors.forename: Ed
authors.initials: E
authors.lastname: Maartense
authors.forename: Anneke M
authors.initials: AM
authors.lastname: Zeilemaker
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Liefers
authors.forename: Lydia van der
authors.initials: Lv
authors.lastname: Geest
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
authors.forename: Johanneke E A
authors.initials: JE
authors.lastname: Portielje
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone