Women 70 or older who were diagnosed with estrogen receptor-positive breast cancer had higher mortality rates when treated with endocrine therapies compared to surgery, a recent U.K. study shows.
The study, “Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival,” was published in the British Journal of Surgery.
In the U.K., more than 30 percent of breast cancer diagnoses are in women older than 70. However, these women are less likely to receive the recommended national treatment guidelines than younger women.
Among those with early stage breast cancer, up to 40 percent of older women receive primary hormone therapy as an alternative to surgery.
Increasing evidence, however, suggests that surgery leads to better breast cancer survival rates than hormone therapies.
To investigate the effects of treatment in the survival of older women with breast cancer, researchers conducted a retrospective analysis using data from the UK Cancer Registry, collected from 2002 to 2010. The data came from two U.K. cancer registry regions, representative of the entire country.
Among the 23,961 women with breast cancer aged 70 or older, 18,730 (78.5%) had estrogen receptor-positive breast cancer. Of these, slightly more than half (53.9%) had surgery, while the remaining patients (46.1%) received primary endocrine therapy.
The mortality rate due to causes other than breast cancer was higher in the primary endocrine therapy group, a consequence of them being frailer and less fit.
After five years, breast cancer-specific survival rates were worse in those who received primary hormone therapy, compared to the surgical group — 69.4% and 89.9%.
“Higher rates of primary endocrine therapy in the UK than in many other developed countries could explain, at least in part, the inferior relative survival for breast cancer in this age group in the UK compared with that in a number of other developed nations,” researchers wrote.
These findings are similar to those of another U.K. study, which included 1,065 patients 70 and older from a single center in Nottingham. The recent study, however, showed a higher difference in breast cancer survival between surgery and hormone therapy.
“Findings from this analysis have been used to develop a web-based clinical management algorithm to help clinical teams decide on best practice for an individual older woman,” researchers wrote.
“Surgery should be recommended for the majority of women, with primary endocrine therapy being reserved for those with limited life expectancy (owing to age, frailty or co-morbidity) or those who express a preference not to undergo surgery,” the study concluded.