Breast Cancer Survival Opportunity Regardless of OP

Surgery does not seem to affect the chances of recovery in elderly patients

09/09/2014

Elderly breast cancer patients are now less likely to undergo surgery than they were 15 years ago. However, as a Dutch documentation shows, the abandonment of an intervention in the survival apparently changes nothing.

In the 1990s, significantly more interventions
Women over 75 years of age and suffering from breast cancer are no longer being operated on as often as they were in the 1990s. This seems strange at first, because breast cancer is the most common malignant tumor of the mammary gland or the most common type of cancer among women in western countries. However, as Dutch data show, the change in therapy does not appear to affect survival, although it is difficult to conclude on the potential benefits of development. After all, the guidelines of the International Society of Geriatric Oncology and the European Society of Breast Cancer Specialists provide that „Patients who are 70 years or older [.] Should be offered the same surgical treatment [should] as younger ".

Breast-conserving treatment today standard
According to the guidelines, the standard treatment for breast cancer is breast-conserving surgery, with large tumors possibly being downsized by upstream drug therapy (neoadjuvant chemotherapy). After surgery, additional breast irradiation usually occurs to reduce the risk of relapse in the remaining tissue. In rarer cases, the breast must also be surgically removed (mastectomy), followed in some cases by radiation therapy. However, contrary to these guidelines, it seems that the operation is much less frequent today than it was 15 to 20 years ago. This is the result of a group of surgeons and oncologists around Nienke de Glas of the Department of Surgery in the Netherlands „Leiden University Medical Center“ (LUMC) come. „Older patients with breast cancer are often not treated in accordance with the guidelines. The development of endocrine therapy may make it unnecessary to have surgery on some patients. The aim of this population-based study was to examine time trends in surgical treatment between 1995 and 2011 and to evaluate the effects of omitting the overall surgery and relative survival in older patients with resectable breast cancer“, so the researchers in the October issue of „British Journal of Surgery“ (BJS).

Dutch researchers examine data from more than 26,000 womenn
According to the researchers, they had examined the data "from a total of 26,292 women over the age of 75, who had been diagnosed with stage I to III breast cancer from 1995 to 2011". The result: "While 90.8 percent of cancer patients had been operated on in 1995, in 2011 this only amounted to 69.9 percent." In the process, the scientists found a "clear connection with age, because the older the women were, the more frequently they would have to refrain from intervention". According to this study, the 75-to-79-year-old's surgery rate in 2011 was only slightly below 100 percent, whereas in the case of over 90-year-old women, it dropped from around 80 percent in 1995 to around 30 percent in 2011.

Proportion of primary endocrine treatments increases significantly between 1995 and 2011
Accordingly, the proportion of primary endocrine treatments increased significantly over the years: While the proportion was only 7.1 percent of older women in 1995, it rose to 27.3 percent by the year 2011. Here, too, the researchers were clear on the connection with age: Earlier, only about 20 percent of over 90-year-old women (and less than 10% of 75- to 79-year-olds) primarily treated endocrine, compared to 70 percent in 2011.

Poorer treatment for older patients?
„Refraining from surgery has become more common in elderly breast cancer patients in the Netherlands over the past 15 years, but this has not changed the overall or relative survival rates“, according to the researchers in the BJS. According to the data, there had been no change in the chance of recovery, although in the years before had operated even more often and had been treated less endocrine. Instead, the five-year survival rate averaged between 50 and 60 percent between 1995 and 2011, being higher among younger women and higher among older women. Similarly, the life expectancy of women with cancer compared to the total age of the same population remained stable at a rate of about 80 percent. Whether the changed treatment methods are now a positive development, according to the researchers can not be easily assessed. Thus, although the chances of recovery of younger women have improved in recent years - but this could also be an indication that older patients in turn not receive adequate treatment, the researchers continue. (No)