Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival

Abstract

PURPOSE Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. PATIENTS AND METHODS We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, > or = 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer-related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age > or = 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age > or = 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). CONCLUSION Women age > or = 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.

Fig 1.

Initial treatment for stage I breast cancer by age at diagnosis. Receipt of treatment differed by age at diagnosis for each stage using the Mantel-Haenszel test of trend (P < .001). BCS, breast-conserving surgery; XRT, radiation therapy.

Fig 2.

Initial treatment for stage II breast cancer by age at diagnosis. Receipt of treatment differed by age at diagnosis for each stage using the Mantel-Haenszel test of trend (P < .001). BCS, breast-conserving surgery; XRT, radiation therapy.

Fig 3.

Receipt of chemotherapy among women with estrogen receptor–negative, lymph node–positive, stage I/II breast cancer.