Lack of Survival Gain for Elderly Women with Breast Cancer
- 15 March 2011
- journal article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 16 (4), 415-423
- https://doi.org/10.1634/theoncologist.2010-0234
Abstract
Background. The number of elderly women with breast cancer is increasing and will become a major health concern. However, little is known about the optimal treatment for this age group. The aim of this study was to describe time trends for the overall Dutch breast cancer cohort with an emphasis on differences between young and elderly patients. Methods. All adult female patients diagnosed in 1995–2005 were selected from the Netherlands Cancer Registry. Relative excess risks for death (adjusted for stage, histology, treatment, and grade) were estimated using a multivariate generalized linear model with a Poisson distribution, based on collapsed relative survival data, using exact survival times. Results. Overall, 127,805 patients were included. Treatment of patients aged ≥75 years changed significantly over time: they received less surgery, more adjuvant hormonal treatment and chemotherapy, and more hormonal treatment without surgery. In contrast to younger patients, the relative survival did not improve significantly over time for elderly patients. With increasing age, the observed–expected death ratio decreased to almost 1.0. Conclusion. Survival for elderly patients with breast cancer did not improve significantly. Observed–expected death ratios in the elderly are close to 1, indicating that excess mortality is low. Elderly patients with breast cancer have a higher risk for overtreatment and undertreatment, with a delicate therapeutic balance between breast cancer survival gain and potential toxicities. To improve breast cancer survival in the elderly, a critical reappraisal is needed of costs and benefits of hormonal as well as other treatments, and better selection of patients who can benefit from available therapies is warranted.Keywords
This publication has 22 references indexed in Scilit:
- Clinical epidemiology of breast cancer in the elderlyEuropean Journal Of Cancer, 2007
- Breast Cancer in the ElderlyJournal of Clinical Oncology, 2007
- Older Female Cancer Patients: Importance, Causes, and Consequences of UndertreatmentJournal of Clinical Oncology, 2007
- Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane reviewBritish Journal of Cancer, 2007
- Time trends of breast cancer survival in Europe in relation to incidence and mortalityInternational Journal of Cancer, 2006
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population-based studyEuropean Journal Of Cancer, 2005
- Survival after treatment for breast cancer in a geographically defined populationBritish Journal of Surgery, 2004
- Cancer and comorbidity in older patients: A descriptive profileAnnals of Epidemiology, 1996
- Influence of age and comorbidity on treatment choice and survival in elderly patients with breast cancerBreast Cancer Research and Treatment, 1991