Originally published as JCO Early Release 10.1200/JCO.2003.02.046 on August 11 2003

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Undertreatment Strongly Decreases Prognosis of Breast Cancer in Elderly Women

Christine Bouchardy, Elisabetta Rapiti, Gérald Fioretta, Paul Laissue, Isabelle Neyroud-Caspar, Peter Schäfer, John Kurtz, André-Pascal Sappino, Georges Vlastos

From the Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University; Clinic of Gynecology, Senology, Department of Obstetrics and Gynecology; Division of Radiation Oncology; Department of Radiology; and Division of Oncology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.

Address reprint requests to Christine Bouchardy, MD, Geneva Cancer Registry, 55 Boulevard de la Cluse 55, 1205 Geneva, Switzerland; e-mail: christine.bouchardymagnin{at}imsp.unige.ch.

Purpose: No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients.

Patients and Methods: We reviewed clinical files of 407 breast cancer patients aged 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment on mortality by Cox model, accounting for prognostic factors.

Results: Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery plus adjuvant treatment.

Conclusion: Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient’s health status, but also should offer the best chance of cure.

Presented as a poster at the 25th San Antonio Breast Cancer Symposium, December 11–14, 2002.

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