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Age‐related variation in the treatment and outcomes of patients with breast carcinoma
Author(s) -
Golledge Jonathan,
Wiggins Joan E.,
Callam Michael J.
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(20000115)88:2<369::aid-cncr18>3.0.co;2-e
Subject(s) - medicine , lymph node , breast cancer , breast carcinoma , tamoxifen , carcinoma , stage (stratigraphy) , oncology , cancer , paleontology , biology
BACKGROUND There is controversy regarding the effect of age on breast carcinoma, and previous analyses have often excluded the most elderly patients as well as those with advanced cancers. This study assessed treatment variations and outcome in relation to age for a complete series of patients who presented with breast carcinoma within a defined geographic district. METHODS Data were collected prospectively for all 784 patients who presented with breast carcinoma in North Bedfordshire, United Kingdom, from 1990 to 1996. Stage of disease, treatment, and outcome were compared for different age groups. RESULTS Older patients had more advanced cancers: 14% of lymph node negative patients age ≥60 years had T3 or T4 tumors compared with 4% of younger lymph node negative patients ( P < 0.0001). Treatment varied with age: 94% of lymph node negative patients age ≥60 years received tamoxifen compared with 73% of younger lymph node negative patients ( P < 0.0001). For lymph node positive patients, outcome was unaffected by age; however, for lymph node negative patients, outcome was best for patients ages 60–69 years: disease free survival was 91% compared with 78% for other ages at 3 years ( P = 0.008), and the locoregional recurrence rate was 2% compared with 7% at 3 years ( P = 0.04). The improvement in the locoregional recurrence rate applied to all lymph node negative patients age ≥60 years: the recurrence rate was 2% compared with 9% for younger patients at 3 years ( P = 0.04). CONCLUSIONS These data support the theory that breast carcinomas are more aggressive in younger patients. The high prescription rate of tamoxifen for older lymph node negative women may have contributed to the low locoregional recurrence rate for this group. Cancer 2000;88:369–74. © 2000 American Cancer Society.