Surgery is safe and improves survival in extremely old aged patients with breast cancer: A retrospective study

Introduction

In 2019, 11% of breast cancers are diagnosed at age 80 or above and this group of older patients constitutes 27% of breast cancer deaths. Previous clinical trials demonstrated comparable survival in older patients given hormonal therapy alone versus standard surgical treatment. However, newer studies showed that surgical treatment in older patients is associated with reduced all-cause and cancer-related mortality. Our study aims to compare the survival of older patients with breast cancer who received surgery versus hormonal therapy alone or expectant management, analyse the factors affecting survival and compare the local complication rates.

Methods

Patients treated under the New Territories East Cluster breast clinic with breast cancer diagnosed at age 80 or above were included in the study. Patients with metastatic disease were excluded. All medical records on the Hospital Authority Clinical Management System were retrospectively reviewed. Predictors including whether surgery was performed, human epidermal growth factor receptor 2 (HER2) status, oestrogen receptor (ER) status, T stage, N stage and activities of daily living status were assessed.

Results

Seventy-eight consecutive patients with breast cancer (median age 85, range 80-99) from 2004 to 2020 were included. Of these, 39 (50%) received surgery, whereas 39 (50%) did not. Patients who received surgery have a longer survival time (median 113 months vs 62 months; log-rank test P = .001). Univariate analysis and multivariate Cox regression model demonstrated that surgery and ER status affect survival. Patients who received surgery also have a lower incidence of local tumour progression and skin ulceration (χ²₁ = 6.3, P = .012).

Conclusion

In older patients with newly diagnosed breast cancer, surgical treatment is associated with a better survival and lower rates of local progression and complications. Surgery is advised even in older patients as long as they are fit for surgery.