Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study

Abstract

Background: Standard treatment of patients with breast cancer decreases with age and older persons are mostly excluded from clinical trials. We hypothesized that non-adherence to treatment guidelines occurs for women aged ≥70 years and changes overall survival (OAS) and disease-free survival (DFS). Patients and methods: We enrolled 1922 women aged ≥50 years with histologically confirmed invasive breast cancer treated at the University of Ulm from 1992 to 2005. Adherence to guidelines and effects on OAS and DFS for women aged ≥70 years was compared with that for younger women (50–69 years). Results: Women >70 years less often received recommended breast-conserving therapy (70–79 years: 74%–83%; >79 years: 54%) than women aged ≤69 years (93%). Non-adherence to the guidelines on radiotherapy (79 years: 60%) and chemotherapy ( 79 years: 98%) increased with age. Omission of radiotherapy significantly decreased OAS [≤69 years: hazard ratio (HR) = 3.29; P P = 0.0005] and DFS (≤69 years: HR = 3.45; P P Conclusion: Our study confirms that substandard treatment increases considerably with age. Omission of radiotherapy had the greatest impact on OAS and DFS in the elderly population.