title: Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology.
abstract: OBJECTIVE
  The 70-year threshold determines whether patients are eligible or not for the breast cancer screening program in Germany. It is not known whether this age threshold also influences the choice of adjuvant treatment and ultimate outcome.
  
  
  METHODS
  3463 patients were analyzed from the clinical cancer registry Regensburg (Germany) with primary, non-metastatic invasive breast cancer diagnosed between 2000 and 2012. The distribution of tumor biological subtypes was evaluated in breast cancer patients both in those eligible for screening (ESG, 50-69 years) and those not eligible for screening (NESG, ≥70 years). Local and systemic therapies in different subtypes as well as overall survival (OS) were analyzed.
  
  
  RESULTS
  2171 patients (62.7%) pertained to the ESG and 1292 patients (37.3%) referred to the NESG. The distribution of the common subtypes Luminal A, Luminal B, HER2-like, and Basal-like was comparable in both groups. Treatment varied considerably with less systemic therapies in all subtypes in patients in the NESG. Regarding local therapies, patients in the NESG also received less surgery and less radiotherapy. As to Luminal A patients, best OS was seen in patients receiving endocrine therapy (ET) (7-year OS of 95.6%) and CHT plus ET (7-year OS of 93.1%) in the ESG. In the NESG, best OS was seen in patients receiving CHT plus ET (7-year OS of 95.2%), whereas patients receiving only ET had a 7-year OS of 73.9%.
  
  
  CONCLUSIONS
  Despite similar tumor biology, elderly patients are undertreated regarding both systemic and local therapies compared to younger patients, leading to reduced OS.
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany. elisabeth.inwald@klinik.uni-regensburg.de.
authors.forename: E C
authors.identifier: http://orcid.org/0000-0001-8731-8481
authors.initials: EC
authors.lastname: Inwald
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Ortmann
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Tumor Center Regensburg, University of Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hofstädter
authors.affiliation: Institute of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Evert
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Brockhoff
authors.affiliation: Tumor Center Regensburg, University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klinkhammer-Schalke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005858:Germany; D054625:Healthcare Disparities; D006801:Humans; D008403:Mass Screening; D008408:Mastectomy; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Breast cancer; Cancer registry; Elderly patients; Mammography screening; Overall survival; Tumor biological subtypes