E. N. Ferrigni1,2, C. Bergom1,2, Z. Yin1, A. Kong1,2 1Medical College Of Wisconsin,Milwaukee, WI, USA 2Froedtert Hospital,Surgical Oncology,Milwaukee, WI, USA
Introduction: With a growing female octogenarian population due to improvements in medical care, there is an increasing number of elderly women diagnosed with breast cancer. No clear standard treatment guidelines exist for older women with invasive breast cancer, and few breast cancer clinical trials include elderly women or examine the impact treatment has on survival. This study aims to examine the practice patterns and treatment outcomes of elderly women ≥80 years old with invasive breast cancer.
Methods: From 2005-2014, female patients ≥80 years old with Stage I-III invasive breast cancer were identified in our hospital tumor registry. Treatments assessed included surgery, radiation, and systemic therapies. Co-morbidities were assessed via the Charlson Comorbidity Index. Descriptive statistics were performed for continuous variables and categorical variables. Kruskal-Wallis and Chi-square tests were applied to evaluate the associated continuous variables and categorical variables, respectively. Kaplan-Meier plot with log-rank test was performed to evaluate survival.
Results: The final cohort consisted of 124 patients. Median age of diagnosis was 84 (range 80-99). 48% of cancers were detected by mammography. 90% of tumors were ER+, 78% were PR+, and 11% were HER2+. 90% of patients underwent surgery (112/124), and those patients were younger (p<0.001). For those who had surgery, 73% underwent a lumpectomy while 27% received a mastectomy. There was no difference in comorbidities between the surgical and non-surgical group (p=0.817). Only 13% of the patients received chemotherapy, whereas 74% and 45% received hormonal therapy and radiation, respectively. Of those who received surgery, 20 patients (12%) experienced complications within 3 months of their procedure. There were 14 cases with reported radiation and/or chemotherapy complications within 3 months. On multivariate analysis, patients greater than the age of 87 (p=0.005) were less likely to have surgery. Overall survival probability (p=0.01) and event-free survival probability (p=0.05) was significant and borderline significant, respectively, in those who received surgery compared to those who did not.
Conclusion: In this cohort, patients who were younger, with image-detected tumors were more likely to undergo surgery. Given the low frequency of complications with surgery, radiation, or chemotherapy, including these therapies as standard of care for octogenarians who have few comorbidities and reasonable longevity should be considered. Further analysis of treatment outcomes in this patient population is warranted to determine the impact of treatment on overall survival.