Distinct Postsurgical Management in Young and Elderly Breast Cancer Patients Results in Equal Survival Rates

  • Oran, Ebru Sen (Department of General Surgery, Bakirkoy Research and Training State Hospital) ;
  • Yankol, Yucel (Department of General Surgery, Bakirkoy Research and Training State Hospital) ;
  • Soybir, Gursel Remzi (Department of General Surgery, Medical Faculty, Namik Kemal University) ;
  • Karsidag, Tamer (Department of General Surgery, Atasehir Memorial Hospital) ;
  • Sakalli, Onur (Department of General Surgery, Medical Faculty, Namik Kemal University) ;
  • Gecgel, Umit (Department of General Surgery, Medical Faculty, Namik Kemal University) ;
  • Soybir, Onur Can (Premed Section, Art of Sciences) ;
  • Soran, Atilla (Department of Breast Surgery, Magge Womens Hospital, University of Pittsburgh)
  • Published : 2014.10.11


Background: Although breast cancer (BC) is one of the most common malignant diseases in women, the majority of the studies describing the characteristics of BC in elderly patients have been limited to survival assessments or tumor features, without using younger BC patients as a reference group. The aim of our study was to describe and compare tumor characteristics and management patterns in elderly versus younger breast cancer patients in Turkey. Materials and Methods: We retrospectively analyzed 152 patients with invasive breast cancer who underwent surgery in our institution between 2002 and 2012. Patients were divided into 2 groups according to age at the time of diagnosis. Results: There were 62 patients in the elderly group (${\geq}65$ years) and 90 patients in the younger group (<65 years). Compared to the younger group, tumors in the elderly group were more likely to be larger (p=0.018), of lower grade (p=0.005), and hormone receptor-positive (p>0.001). There were no significant differences regarding histology, localization, lymph node involvement, or types of surgical procedures between the 2 groups. Comorbidities were more common in elderly patients (p<0.001). In addition, elderly patients were more likely to receive hormonal therapy (p<0.001) and less likely to receive radiotherapy (p=0.08) and chemotherapy (p=0.003). There was no difference in survival and locoregional recurrence rates between the groups. Conclusions: The results of this study demonstrate that breast cancer in elderly patients has more favorable tumor features, warranting less aggressive treatment regimens after surgery.


  1. August DA, Rea T, Sondak VK (1994). Age-related differences in breast cancer treatment. Ann Surg Oncol, 1, 45-52.
  2. Bland KI, Scott-Conner CE, Menck H, Winchester DP (1999). Axillary dissection in breast- conserving surgery for stage I and II breast cancer: a national cancer data base study of patterns of omission and implications for survival. J Am Coll Surg, 188, 586-95.
  3. Bonnier P, Romain S, Charpin C, et al (1995). Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer, 62, 138-44.
  4. Bouchardy C, Rapiti E, Fioretta G, et al (2003). Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol, 21, 3580-7.
  5. Daidone MG, Coradini D, Martelli G, Venerani S (2003). Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol, 45, 313-25.
  6. Diab SG, Elledge RM, Clark G (2000). Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst, 92, 550-6.
  7. Downey L, Livingston R, Stopeck A (2007). Diagnosing and treating breast cancer in elderly women: a call for improved understanding. J Am Geriatr Soc, 55, 1636-44.
  8. Fentiman IS (2013). Management of operable breast cancer in older women. J R Soc Med, 106, 13-8.
  9. Fisher B, Jeong JH, Anderson S, et al (2002). Twenty-fiveyear follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy with irradiation. N Engl J Med, 347, 567-75.
  10. Grube BJ, Hansen NM, Ye W, Herlong T, Gluliano AE (2001). Surgical management of breast cancer in the elderly patient. Am J Surg, 182, 359-64.
  11. Fisher CJ, Egan MK, Smith P, et al (1997). Histopathology of breast cancer in relation to age. Br J Cancer, 75, 593-6.
  12. Gennari R, Audisio RA (2008). Breast cancer in elderly women. Optimizing the treatment. Breast Cancer Res Treat, 110, 199-209.
  13. Gennari R, Curigliano G, Rotmensz N, et al (2004). Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer, 101, 1302-10.
  14. Güth U, Myrick ME, Kandler C, Vetter M (2013). The use of adjuvant endocrine breast cancer therapy in the oldest old. Breast, 22, 863-8.
  15. Harder H, Ballinger R, Langridge C, Ring A, Fallowfield LJ (2013). Adjuvant chemotherapy in elderly women with breast cancer: patients' perspectives on information giving and decision making. Psychooncology, 22, 2729-35.
  16. Hughes S, Barbachano Y, Ashley S, et al (2008). Time trends in the outcome of elderly patients with breast cancer. Breast J, 14, 158-63.
  17. Kesseler HJ, Seton JZ (1978). The treatment of operable breast cancer in the elderly female. Am J Surg, 135, 664-6.
  18. Ma CD, Zhou Q, Nie XQ, et al (2009). Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns. Crit Rev Oncol Hematol, 71, 258-65.
  19. Malik MK, Tartter PI, Belfer R (2013). Undertreated breast cancer in the elderly. J Cancer Epidemiol, 2013, 893104.
  20. Phua CE, Bustam AZ, Yip CH, Taib NA (2010). Prognostic factors for elderly breast cancer patients in University Malaya Medical Centre, Malaysia. Asian Pac J Cancer Prev, 11, 1205-11.
  21. Mohamed NA, Muhamad M (2013). Older women breast cancer survivors: decision making, sources of information and wellness activities in Malaysia. Asian Pac J Cancer Prev, 14, 2043-48.
  22. Molino A, Giovannini M, Auriemma A, et al (2006). Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol, 59, 226-33.
  23. Passage KJ, McCarthy NJ (2007). Critical review of the management of early-stage breast cancer in elderly women. Intern Med J, 37, 181-9.
  24. Pierga JY, Girre V, Laurence V, et al (2004). Institut Curie Breast Cancer Study Group. Characteristics and outcome of 1755 operable breast cancer in women over 70 years of age. Breast, 13, 369-75.
  25. Rao VS, Garimella V, Hwang M, Drew PJ (2007). Management of early breast cancer in the elderly. Int J Cancer, 120, 1155-60.
  26. Satariano WA, Ragland DR (1994). The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med, 120, 104-10.
  27. Siegelmann-Danieli N, Khandelwal V, Wood GC, et al (2006). Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach. Clin Breast Cancer, 7, 59-66.
  28. Smith GL, Xu Y, Shih YC, et al (2009). Breast-conserving surgery in older patients with invasive breast cancer: current patterns of treatment across the United States. J Am Coll Surg, 209, 425-33.
  29. Theriault RL, Litton JK, Mittendorf EA, et al (2011). Age and survival estimates in patients who have node-negative T1ab breast cancer by breast cancer subtype. Clin Breast Cancer, 11, 325-31.
  30. Syed BM, Green AR, Paish EC, et al (2013). Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts. Br J Cancer, 108, 1042-51.
  31. Tang SW, Parker H, Winterbottom L, et al (2011). Early primary breast cancer in the elderly- pattern of presentation and treatment. Surg Oncol, 20, 7-12.
  32. Thapa B, Singh Y, Sayami1 P, et al (2013). Breast cancer in young women from a low risk population in Nepal. Asian Pac J Cancer Prev, 14, 5095-99.
  33. Thomas GA, Leonard RC (2009). Breast cancer in the elderly. Clin Oncol (R Coll Radiol), 21, 79-80.
  34. Tipples K, Robinson A (2009). Optimizing care of elderly breast cancer patients: a challenging priority. Clin Oncol (R Coll Radiol), 21, 118-30.
  35. Vrana D, Gatek J, Lukesova L, et al (2013). Omission of adjuvant radiation therapy in elderly patients with low risk breast cancer undergoing breast-conserving surgery - two center experience. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 157, 1-4.
  36. Wanebo HJ, Cole B, Chung M, et al (1997). Is surgical management compromised in elderly patients with breast cancer? Ann Surg, 225, 579-86.
  37. Wei XQ, Li X, Xin XJ, Tong ZS, Zhang S (2014). Clinical features and survival analysis of very young (age<35) breast cancer Patients. Asian Pac J Cancer Prev, 14, 5949-52.
  38. Wildiers H (2008). Challenges in treating older cancer patients: breast cancer. Ann Oncol, 19, 99-103.
  39. Zhao YM, Wang JT, Liu J, et al (2014). Differences between breast cancer patients younger and older than 40 years: mammographic findings. Asian Pac J Cancer Prev, 15, 4929-32
  40. Wyld L, Reed M (2007). The role of surgery in the management of older women with breast cancer. Eur J Cancer, 43, 2253-63.
  41. Yellen SB, Cella DF, Leslie WT (1994). Age and clinical decision making in oncology patients. J Natl Cancer Inst, 86, 1766-70.
  42. Yood MU, Owusu C, Buist DS, et al (2008). Mortality impact of lessthan-standard therapy in older breast cancer patients. J Am Coll Surg, 206, 66-75.

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