title: Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: a tamoxifen exemestane adjuvant multinational study analysis.
abstract: BACKGROUND
  For postmenopausal patients with hormone-sensitive breast cancer, outcome is worse with increasing age at diagnosis. The aim of this study was to assess the incidence of breast cancer recurrence (locoregional and distant), and contralateral breast cancer by age at diagnosis.
  
  
  METHODS
  Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial were included. Primary endpoints were locoregional recurrence, distant recurrence, and contralateral breast cancer. Age at diagnosis was categorized as younger than 65 years, 65-74 years, and 75 years or older.
  
  
  RESULTS
  Overall, 9,766 patients were included, of which 5,349 were younger than 65 years (reference group), 3,060 were 65-74 years, and 1,357 were 75 years or older. With increasing age, a decreased administration of radiotherapy after breast conserving surgery (94%, 92%, and 88%, respectively) and adjuvant chemotherapy (51%, 23%, and 5%, respectively) was observed. Risk of distant recurrence increased with age at diagnosis; multivariable hazard ratio for patients aged 65-74 years was 1.20 (95% confidence interval [CI]: 1.00-1.44), hazard ratio for patients aged 75 years or older was 1.39 (95% CI: 1.08-1.79). Risks of locoregional recurrence and contralateral breast cancer were not significantly different across age groups.
  
  
  CONCLUSIONS
  Elderly patients with breast cancer were at increased risk for distant recurrence. Other studies have shown that the risk of distant recurrence is mainly affected by adjuvant systemic therapy. All TEAM patients received adjuvant endocrine treatment; however, chemotherapy was administered less often in elderly patients. These findings are suggestive for consideration of chemotherapy in relatively fit elderly breast cancer patients with hormone-sensitive disease.
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Willemien
authors.initials: W
authors.lastname: van de Water
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: Christos
authors.initials: C
authors.lastname: Markopoulos
authors.forename: Steve E
authors.initials: SE
authors.lastname: Jones
authors.forename: Daniel
authors.initials: D
authors.lastname: Rea
authors.forename: Annette
authors.initials: A
authors.lastname: Hasenburg
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Elysée T M
authors.initials: ET
authors.lastname: Hille
authors.forename: Robert
authors.initials: R
authors.lastname: Paridaens
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Liefers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D017698:Postmenopause; D012008:Recurrence; D013629:Tamoxifen / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D013629:Tamoxifen; C056516:exemestane