Breast cancer in women 80 years of age and older: a comprehensive analysis of an underreported entity.
BACKGROUND
Approximately 10% of breast cancer (BC) patients are over the age of 80. We present the first comprehensive review on this particular group of patients.


METHODS
The treatments and disease courses of an unselected cohort of patients, whose age at first diagnosis was ≥ 80 years (n = 151), were compared to those of a group of women, who were aged 56-66 years (n = 372).


RESULTS
The group of elderly patients had larger tumors at first diagnosis (25 mm vs. 18 mm, p < 0.001) and higher disease stages (I: 31.1% vs. 44.1%, IV: 11.9% vs. 5.4%; each p < 0.001). There were no significant differences between both groups in terms of histologic subtype, grading, hormonal receptor status and HER2 status. The tumors of older patients were more often detected by clinical examination (38.9% vs. 17.0%, p < 0.001) and less often by mammography/sonography (10.4% vs. 29.9%, p < 0.001). The rate of patients who died of BC were similar in both groups (21.2% vs. 21.5%, p = 1.00). In the patients who had no evidence of metastases and who opted for primary non-surgical management (n = 21), the tumor could be stabilized without considerable morbidity in only 42.9%. Persistence to adjuvant endocrine therapy was comparable (83.0% vs. 88.3%, p = 0.357). In the adjuvant as well as in the palliative settings, elderly patients received less chemotherapy than younger ones (adjuvant: 1.6% vs. 23.3%; palliative: 32.3% vs. 68.4%; each p < 0.001). For palliative treatments only, elderly patients received fewer treatment regimens (≥ 3 therapy lines: 16.0% vs. 54.9%, p < 0.001). In those patients who died of BC, elderly women had inferior overall (25 vs. 54.5 months, p < 0.001) as well as metastatic-disease survival (11.5 vs. 19 months, p = 0.062).


CONCLUSIONS
It must be ensured that appropriate standard therapies should not be routinely withheld in older patients based on erroneous perceptions regarding the biological nature of BC in the elderly and lack of knowledge about available therapy regimens. Physicians should consider that preservation of current life circumstances and maintenance of quality of life are frequently more important than "classical" hard medical facts such as survival times.
University Hospital Basel (UHB), Breast Center, Basel, Switzerland.
Marcus
M
Vetter
Dorothy Jane
DJ
Huang
Georg
G
Bosshard
Uwe
U
Güth
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D010166:Palliative Care; D010808:Physical Examination / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D016312:Treatment Refusal
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal