The influence of older age on breast cancer treatment decisions and outcome Journal Article

Authors: Merchant, T. E.; McCormick, B.; Yahalom, J.; Borgen, P.
Article Title: The influence of older age on breast cancer treatment decisions and outcome
Abstract: Purpose: Information concerning the differences between older and younger women with breast cancer, treated with standard therapy, is lacking from many prospective series. The purpose of this study is to identify factors that influence treatment decisions and determine if women age 65 and older are treated differently than younger women. The outcomes of older women would then be compared to younger women to determine if treatment differences influence outcome. Methods and Materials: The records of 558 women with early invasive breast cancer who were treated with breast conserving surgery and radiation therapy were retrospectively reviewed. Four hundred thirty-two women under the age of 65 (range: 24-64) and 126 women age 65 and older (range: 65-85) were assessed for treatment differences including breast reexcision, extent of axillary dissection, extent of breast and nodal irradiation, and the use of chemotherapy or hormonal therapy. Differences in the treatment of the two groups were determined and the end points of local control, disease-free survival, and overall survival were compared. Median follow-up was 5.5 years. Results: The two treatment groups had identical pathologic TNM staging with the exception that 21% of the older age group and 5% of the younger age group did not undergo axillary dissection. Women age 65 and older were less likely to have a reexcision, extensive axillary dissection, chemotherapy, or nodal irradiation. They were more likely to receive hormonal therapy. Reexcision in older women was positively influenced by a family history of breast cancer and negatively influenced by a history of previous malignancy. None of the patients who were treated without an axillary dissection suffered a regional recurrence. Although local control was better in older patients, there were no differences in disease-free or overall survival for the two groups. Discussion: The findings of this study reveal that older patients have significant treatment differences as compared to younger patients; however, despite these differences, similar local control and survival were achieved at 5 and 10 years. With the expected survival of older women increasing, the prospective evaluation of treatment options for older women should be considered.
Keywords: adult; cancer chemotherapy; cancer survival; treatment outcome; aged; major clinical study; treatment planning; cancer radiotherapy; cancer staging; lymph node dissection; breast cancer; retrospective study; cancer hormone therapy; axillary lymph node; tamoxifen; breast surgery; breast-conserving therapy; human; female; priority journal; article; older-aged women
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 34
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 1996-02-01
Start Page: 565
End Page: 570
Language: English
DOI: 10.1016/0360-3016(95)02167-1
PUBMED: 8621279
PROVIDER: scopus
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Joachim Yahalom
    494 Yahalom
  2. Patrick I Borgen
    253 Borgen
  3. Beryl McCormick
    333 McCormick