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MANAGEMENT OF BREAST CANCER IN THE ELDERLY BY COMPLETE LOCAL EXCISION AND TAMOXIFEN ALONE
Author(s) -
Sader CHADY,
Ingram DAVID,
Hastrich DIANA
Publication year - 1999
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1046/j.1440-1622.1999.01696.x
Subject(s) - medicine , breast cancer , tamoxifen , axilla , radiation therapy , axillary lymph node dissection , mammography , population , surgery , cancer , axillary lymph nodes , wide local excision , sentinel lymph node , environmental health
Background : Breast cancer in the elderly is a significant problem, with ~ 30% of all breast cancers occurring in women who are aged 70 or more. Treatments such as axillary dissection, radiotherapy and chemotherapy, part of standard therapy in younger women, have a considerable morbidity and may not be well tolerated in the elderly. The authors report their experience with a more conservative approach to breast cancer in the elderly, using complete local excision combined with long‐term tamoxifen (CLE and Tam). Methods : Seventy women aged ≥ 70 years (median age: 79.5 years; range: 70–93 years) were treated by CLE and Tam, and were followed for a median of 25 months (range: 1–82 months). The study population of 70 women represented a less fit group, with tumours suitable for a breast‐conserving approach and without palpable axillary lymph nodes. Follow‐up was by clinical examination and annual mammography. Results : Loco‐regional failure occurred in seven women (10%), three of which involved the breast alone, three the axilla alone, and one involved both sites. Five patients had further surgery. Six of the seven patients had high‐grade tumours and two of them were oestrogen receptor‐negative. Four of the failure group have subsequently died: two with metastatic breast cancer and two from non‐malignant disease. Of the whole study group, there have been 12 deaths in the follow‐up period: three from metastatic breast cancer and nine from unrelated medical illness. Conclusions : It is believed that CLE and Tam provide a simple and safe approach for early non‐high‐grade breast cancers in elderly women. By such an approach, a large number of elderly women can avoid axillary dissection and radiotherapy.