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Nodal positivity decreases with age in women with early‐stage, hormone receptor–positive breast cancer
Author(s) -
DownsCanner Stephanie M.,
Gaber Charles E.,
Louie Raphael J.,
Strassle Paula D.,
Gallagher Kristalyn K.,
Muss Hyman B.,
Ollila David W.
Publication year - 2020
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/cncr.32668
Subject(s) - medicine , breast cancer , stage (stratigraphy) , cohort , estrogen receptor , cancer , oncology , incidence (geometry) , cancer registry , axilla , gynecology , paleontology , physics , optics , biology
Background Despite data demonstrating the safety of omitting axillary surgery in older women with early‐stage breast cancer, the incidence of axillary surgery remains high. It was hypothesized that the prevalence of nodal positivity would decrease with advancing age. Methods The National Cancer Data Base was used to construct a cohort of adult women with early‐stage, clinically node‐negative, estrogen receptor–positive (ER+), human epidermal growth factor receptor 2–negative breast cancer treated between 2013 and 2015. Multivariable logistic regression was used to assess the relationship between age and nodal positivity, and this was stratified by the axillary surgery category. Modified Poisson regression was used to estimate the proportion of women receiving adjuvant therapy according to age and nodal status. Results The incidence of axillary surgery among women aged 70 and older (n = 51,917) remained high nationwide (86%). There was a significant decrease in nodal positivity with advancing age in women with early‐stage, ER+, clinically node‐negative breast cancer from the youngest cohort up to patients aged 70 to 89 years, and this was independent of histologic subtype (ductal vs lobular), race, comorbidities, and socioeconomic factors. Overall, less than 10% of women aged 70 or older who underwent surgery had node‐positive disease, regardless of axillary surgery type, and almost 95% of node‐positive patients aged 70 or older were at pathological stage N1mi or N1. Conclusions Axillary surgery may be safely omitted for many older women with ER+, clinically node‐negative, early‐stage breast cancer. Nodal positivity declines with advancing age, and this suggests varied biology in older patients versus younger patients.