Older Women with Breast Cancer Can Tolerate Surgery, But Often Pursue Other Treatment Options

Research suggests that a majority of women over the age of 70 with breast cancer can tolerate surgery and only the least fit women should not be offered surgery to bridge the gap of survival rates between older and younger women, according to a study presented at the 12th European Breast Cancer Conference.

The research detailed that older women are sometimes not offered surgery, chemotherapy, or radiotherapy because their doctors do not believe these patients can tolerate the treatment nor benefit much from them. Overall, these decisions ultimately may contribute to worse breast cancer survival rates for older women, compared with younger women.

“For most women, surgery is well tolerated and should be the aim of treatment if possible, as we have shown that surgery is generally well tolerated and survival rates are slightly lower in women who do not have surgery,” Lynda Wyld, professor of surgical oncology at the University of Sheffield, UK, said in a press release. “However, when we looked at the two treatments in a less fit group of older women, these differences in breast cancer survival disappeared.”

The study included 3416 women from 56 different UK breast cancer units. Of the 2979 women whose cancer was driven by the estrogen hormone (ER positive), the research found that 2354 (82%) were treated with surgery and 500 (18%) with anti-estrogen tablets only.

More, the unadjusted death rates for patients with breast cancer 45 out of 476 (9.5%) for the tablet-only group compared to 113 out of 2293 (4.9%) for the surgery group. When adjusting for age, tumor stage, other diseases, and levels of activity, the researchers identified 426 women who received surgery and 240 who received tablets only of similar age, frailty and fitness levels. This data found that 79 out of 229 (34.5%) women treated with tablets only died of any cause compared to 106 out of 414 (25.6%) surgery patients at 52 months follow-up.

Of the entire cohort, there were no deaths attributed to surgery and only 2% of women experienced serious side effects from this procedure.

“The tablet-only group were an average of eight years older and significantly less fit than the surgery group,” Wyld said. “Not surprisingly, when unadjusted analysis of overall survival was performed, 203 of the 486 women on tablets only, for whom we have complete data, died compared to 336 out of 2307 women treated with surgery after follow-up of 52 months.”

To this point, the researchers explained that there are no current guidelines to assist clinicians and patients in choosing the most appropriate treatment with regard to varying fitness levels. The data from this research has been used to develop online tools to determine who will benefit from surgery, specifically for older women with breast cancer.

While details from the abstract concluded that surgery was more effective that hormone therapy alone, a second abstract presented suggests this cohort of women more often than not opted to not have surgery.

The researchers hope that these details will not only help reduce the practice variability for older patients, but also improve outcomes and help patients make a more informed decision regarding their treatment options.

“This was a surprise to us, but it reflects the importance of giving women the right to choose based on their own personal priorities,” said Wyld. “What we have found is that although more women who used the decision support tools received hormone tablet-only therapy rather than surgery, the survival rate from breast cancer was similar regardless. However, this needs to be confirmed by data after longer follow-up.”

Reference:

Bridging the age gap: two studies show how older breast cancer patients can be treated more effectively [news release]. Published October 1, 2020. https://www.sheffield.ac.uk/medicine/news/bridging-age-gap-two-studies-show-how-older-breast-cancer-patients-can-be-treated-more-effectively. Accessed November 3, 2020.