title: Operation with less adjuvant therapy for elderly breast cancer.
abstract: The standard of care for elderly women with breast cancer remains controversial. The aim of this study was to clarify the management of elderly breast cancer patients who undergo surgery.
  
  
  
  This retrospective single-center cohort study included 2276 breast cancer patients who underwent surgery between 1993 and 2014. The patients were divided into three groups according to age: ≤64 y (young), 65-74 y (older), and ≥75 y (elderly).
  
  
  
  The elderly had more advanced stage disease at diagnosis (stage III and IV, 16.2%, 17.5%, and 22.1% for the young, older, and elderly groups, respectively). The elderly were more likely to undergo mastectomy (43.3%, 41.4%, and 50.7%, respectively), omit axillary operation (0.6%, 1.1%, and 9.3%, respectively), and skip radiotherapy after breast-conserving surgery (93.1%, 86.8%, and 29.1%, respectively). Endocrine therapy was widely used in all the groups (94.4%, 93.8%, and 90.1%, respectively), but frequency of chemotherapy was lower in the elderly regardless of hormone receptor (HR) status (40.8%, 25.5%, and 9.3% in HR(+), 87.2%, 75.3%, and 39.5% in HR(-), respectively). Although the locoregional recurrence rate was higher in the elderly (4.2%, 3.4%, and 7.0% at 5 y, respectively; P = 0.028), there were no differences among groups in distant metastasis-free survival or breast cancer-specific survival.
  
  
  
  Although elderly patients had more advanced stages of cancer and received less treatment, there were no differences in survival. Omission of axillary dissection, radiation, and chemotherapy after operation may be an option for breast cancer patients aged ≥75 y.
authors: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan. Electronic address: yakimitsu@gmail.com.
authors: Akimitsu
authors: A
authors: Yamada
authors: Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
authors: Kazutaka
authors: K
authors: Narui
authors: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Kanagawa, Japan.
authors: Sadatoshi
authors: S
authors: Sugae
authors: Department of Breast Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan.
authors: Daisuke
authors: D
authors: Shimizu
authors: Breast Surgery, Roswell Park Cancer Institute, Buffalo, New York.
authors: Kazuaki
authors: K
authors: Takabe
authors: Department of Oncology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
authors: Yasushi
authors: Y
authors: Ichikawa
authors: Department of Breast Disease, Tokyo Medical University Hospital, Tokyo, Japan.
authors: Takashi
authors: T
authors: Ishikawa
authors: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Kanagawa, Japan.
authors: Itaru
authors: I
authors: Endo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008408:Mastectomy / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Breast cancer; Elderly; Prognosis; Radiotherapy; Surgery; Systemic therapy