Breast cancer patients aged 70 and over: clinical characteristics, treatment, and prognosis

초록

Goals: Breast cancer incidence in the elderly is rising with overall increased life-expectancy. Evidence-based treatment guidelines for this subgroup, however, is lacking as women over the age of 70 have been largely excluded from clinical trials. Older patients are more prone to under-treatment due to their comorbidities, frailty, and consensus that breast cancer in older women are associated with more favorable prognostic factors. The aim of this study was to verify tumor characteristics in patients 70 years and older, review treatments they received, and compare recurrence and breast-cancer specific survival to those of younger subgroups to validate the appropriateness of current management in older breast cancer patients. Methods: From January 2009 to December 2019, newly diagnosed breast cancer patients of 50 years old or over who underwent curative surgery in Korea University Guro Hospital were enrolled in this study. Patients were categorized into 2 groups: those aged 70 years and over, and those between 50 and 69 years old. Their clinical characteristics including subtypes, histologic grade, lymph node status, and stage were collected. Treatments that patients received were reviewed, and patients’ breast-cancer specific survival and disease-free survival were evaluated. Results: A total of 1423 patients was enrolled in this study. 190 patients (13.4%) received surgery at over the age of 70. Luminal B was the most common subtype (n = 75, 39.5%) followed by luminal A subtype (n = 45, 23.7%). These patients mostly presented with stage 2 (38.4%) and stage 1 (36.3%) disease. 5-year breast cancer specific survival rate in older age group was 96%, while it was 99% for age group of 50–69 years old, with a significant statistical difference (p = 0.010). 5-year disease free survival also showed a statistically significant difference – 89% in the older age group and 94.4% in the younger age group. Conclusion(s): In older patients at or above the age of 70, 5-year disease free survival and breast cancer specific survival turned out lower than that of patients aged 50–69. With increasing life expectancy and improving health care, it may be time to reconsider what the most appropriate treatment for elderly breast cancer patients to ensure better survival and quality of life.