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. 2021 Mar 12;108(2):160-167.
doi: 10.1093/bjs/znaa042.

Surgical decisions in older women with early breast cancer: patient and disease factors

Y Jauhari  1 , M R Gannon  1   2 , D Dodwell  3 , K Horgan  4 , K Clements  5 , J Medina  1 , D A Cromwell  1   2
Affiliations

Surgical decisions in older women with early breast cancer: patient and disease factors

Y Jauhari et al. Br J Surg. .

Abstract
in English, Spanish

Background: Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer .

Methods: Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery.

Results: Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness.

Conclusion: The reasons for the observer differences should be further explored to ensure consistency in treatment decisions.

Antecedentes: Los estudios que publican una tasa menor de cirugía en las mujeres mayores con cáncer de mama invasivo precoz se han centrado en mujeres con tumores positivos para receptores de estrógeno (estrogen receptor ER). Este trabajó analizó los factores que influyen en la realización de cirugía de mama en mujeres mayores con cáncer de mama invasivo precoz ER positivo y ER negativo.

Métodos: A partir del registro de cáncer inglés y galés y de las bases de datos hospitalarias se identificaron las mujeres de ≥ 50 años con cáncer de mama invasivo precoz unilateral en estadios 1-3A diagnosticados entre 2014-2017. Se utilizó una regresión logística para evaluar la influencia del tumor y los factores de la paciente en la práctica de la cirugía.

Resultados: De 83.188 mujeres con cáncer de mama invasivo precoz, el 87% tenía ER positivo y un 13% ER negativo. Este porcentaje no se vio afectado por la edad en el momento del diagnóstico. En comparación con las mujeres con cáncer de mama ER negativo, las mujeres con cáncer de mama ER positivo tuvieron tumores de bajo riesgo: G1 (20% versus 2%), T1 (61% versus 44%) y N0 (74% versus 69%). Los porcentajes de mujeres con alguna comorbilidad (14% versus 14%) o con algún grado de fragilidad (25% versus 26%) fueron similares entre las mujeres con ER positivo y ER negativo, respectivamente. La tasa de no realización de cirugía fue del 6%, 11% y 42% en las mujeres con cáncer de mama invasivo precoz ER positivo de 70 a 74 años, 75 a 79 años y ≥ 80 años, respectivamente. Estas tasas fueron del 4%, 4% y 12% en las mujeres con cáncer de mama invasivo precoz ER negativo. La tasa relativamente más baja de cirugía para el cáncer de mama ER positivo persistió en mujeres con buen estado físico.

Conclusión: En Inglaterra y Gales, la indicación de cirugía en pacientes mayores sin contraindicación quirúrgica es menor en los carcinomas de mama precoz invasivos ER positivo en comparación con los ER negativo. Deben analizarse las razones de estas diferencias para garantizar una coherencia en las decisiones del tratamiento en las mujeres mayores.

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Figures

Fig. 1
Fig. 1
Total number of women diagnosed with unilateral early invasive breast cancer and proportion with oestrogen receptor-negative disease in 2014–2017, by age group at diagnosis EIBC, early invasive breast cancer; ER. oestrogen receptor.
Fig. 2
Fig. 2
Observed rate of mastectomy and breast-conserving surgery in women with unilateral early invasive breast cancer, by age at diagnosis and oestrogen receptor status BCS, breast-conserving surgery; ER, oestrogen receptor; EIBC, early invasive breast cancer.
Fig. 3
Fig. 3
Predicted rate of surgery for women with oestrogen receptor-positive and oestrogen receptor-negative early invasive breast cancer, by age at diagnosis for four risk subgroups a Low-risk early invasive breast cancer (EIBC) (grade 1, stage T1 N0), no co-morbidity or frailty; b high-risk EIBC (grade 3, stage T2 N1), no co-morbidity or frailty; c low-risk EIBC, severe co-morbidity or frailty; d high-risk EIBC, severe co-morbidity or frailty. ER, oestrogen receptor.
See this image and copyright information in PMC

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