Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival
- 20 April 2010
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 28 (12), 2038-2045
- https://doi.org/10.1200/jco.2009.25.9796
Abstract
Purpose: Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. Patients and Methods: We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, ≥ 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer–related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results: In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age ≥ 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age ≥ 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). Conclusion: Women age ≥ 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.This publication has 31 references indexed in Scilit:
- Limits of observational data in determining outcomes from cancer therapyCancer, 2008
- Effectiveness of Adjuvant Tamoxifen Therapy among Older Women with Early Stage Breast CancerThe Breast Journal, 2007
- Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older womenBreast Cancer Research and Treatment, 2006
- Breast Cancer Treatment of Older Women in Integrated Health Care SettingsJournal of Clinical Oncology, 2006
- Sensitivity of the hazard ratio to nonignorable treatment assignment in an observational studyStatistics in Medicine, 2006
- Effectiveness of Radiation Therapy for Older Women With Early Breast CancerJNCI Journal of the National Cancer Institute, 2006
- The consequence of undertreating breast cancer in the elderlyJournal of the American College of Surgeons, 2001
- Factors Associated With Surgical and Radiation Therapy for Early Stage Breast Cancer in Older WomenJNCI Journal of the National Cancer Institute, 1996
- Estrogen and Progesterone Receptor Analyses in More Than 4000 Human Breast Cancer Samples: A Study with Special Reference to Age at diagnosis and stability of analysesActa Oncologica, 1990
- The Autopsy as a Measure of Accuracy of the Death CertificateThe New England Journal of Medicine, 1985