J. Frebault1, C. Bergom2, M. Shukla2, Y. Zhang3, C. Huang3, A. Kong1 1Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Department Of Radiation Oncology,Milwaukee, WI, USA 3University of Wisconsin-Milwaukee,Zilber School Of Public Health,Milwaukee, WI, USA
Introduction:
Women aged ≥80 are an increasing proportion of patients diagnosed with breast cancer in the US. There are no established guidelines for decision making in this population, particularly due to consideration of performance status and competing comorbidities. This study aims to identify national treatment patterns and survival outcomes in breast cancer patients aged 80 and over.
Methods:
Women aged ≥80 diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer from 2005-2014 were identified in the National Cancer Database. We excluded cases with incomplete staging and treatment details. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate survival outcomes. Chi-square and logistic regression models were used to identify demographic, disease, and facility factors that influenced receipt of breast surgery.
Results:
We identified 62575 women with invasive cancer and 6070 with DCIS. Of the invasive cases, 94% received breast surgery. Age <85, white race, lower stage, and smaller tumor size were associated with receipt of surgical treatment (p<0.0001 for all). Those who received breast surgery were more likely to be estrogen receptor (ER)+ (p=0.001), HER2- (p<0.0001), and healthier, with a comorbidity score of 0 or 1 (p<0.0001). They were also more likely to have axillary surgery (p<0.0001), chemotherapy (p=0.0009), and radiation (p<0.0001). Among DCIS patients, 98% had breast surgery. White patients (p=0.003) and those <85 years old (p<0.0001) were more likely to receive surgery. Those who had surgery were more likely to receive radiation (p<0.0001). When compared to academic programs, surgical management was more likely to be performed in community cancer centers for both invasive cancer (p<0.0001) and DCIS (p=0.04). On multivariate analysis of invasive cancer patients, those with white race, age <90, lower stage, ER-, or fewer comorbidities were more likely to have surgery (all p<0.0001). On multivariate analysis of DCIS patients, those age <90 were more likely to have surgery (p<0.0001). Black women were half as likely to receive surgery (p=0.02). In both groups, overall survival was higher for those who received surgery compared to those who did not (p<0.0001), with a hazard ratio of 3.3 [95% CI 3.18-3.46] for invasive cancer (Fig. 1) and 2.2 [95% CI 1.72-2.83] for DCIS.
Conclusion:
The vast majority of breast cancer patients age ≥80 in this nationwide dataset received primary surgical management, which was associated with a significant survival advantage for both invasive and non-invasive disease. Surgical intervention should be considered in patients with few comorbidities and favorable tumor characteristics.
