Primary endocrine therapy as a treatment for older women with operable breast cancer - a comparison of randomised controlled trial and cohort study findings.
BACKGROUND
One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection.


METHODS
A systematic review of the literature was performed to try and establish if this form of treatment is still valid in modern breast practice.


RESULTS
Six randomised controlled trials (RCTs) and 31 non-randomised studies were deemed eligible. Available data demonstrate an advantage for surgery over PET in terms of disease control and a likely survival benefit in patients with a predicted life expectancy of five years or more. Patients treated only with aromatase inhibitors (AIs) had superior rates of disease control when compared to Tamoxifen.


CONCLUSIONS
Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: j.morgan@sheffield.ac.uk.
J L
JL
Morgan
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: m.w.reed@sheffield.ac.uk.
M W
MW
Reed
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: l.wyld@sheffield.ac.uk.
L
L
Wyld
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors
Breast cancer; Elderly; Primary endocrine therapy; Surgery; Systematic review