MAMMARY CARCINOMA IN OLD AGE

Tumour excision plus continuous tamoxifen compared with modified radical mastectomy in patients over 70 years of age with operable breast cancer

Between 1985 and 1991, we randomly assigned 77 women over the age of 70 years with stage I-3a breast cancer to undergo a modified radical mastectomy or tumour excision followed by tamoxifen. Median follow-up was 45 months. Patients treated by tumour excision and tamoxifen had a significantly better survival (P = 0.04). The disease-free survival of the tumour excision and tamoxifen group was close to significantly better (P = 0.10). Only two patients in the tamoxifen group required an axillary dissection on follow-up for progressive nodal enlargement. Two patients underwent a local mastectomy for locally recurrent disease. We conclude that tumour excision followed by continuous tamoxifen is an acceptable, safe alternative to a modified radical mastectomy in patients over 70 years of age.

Breast carcinoma in women 35 years of age or younger

The relationship of the age at diagnosis and prognosis in breast carcinoma remains controversial. A widely held perception is that the disease has a particularly unfavorable prognosis in young women. To examine this question we have studied 166 women treated for primary operable breast carcinoma who were 35 years of age or younger at the time of diagnosis. Groups of patients treated consecutively in each of two time periods nearly a decade apart (1964-1970 and 1976-1979) have been studied. Differences between the patient groups in primary surgical treatment and postoperative adjuvant therapy were characterized in the 1970s by the increasing use of modified radical mastectomy and replacement of postoperative radiation therapy by systemic adjuvant chemotherapy. A trend to earlier stage of disease was found among patients treated in 1976 to 1979, but 5-year recurrence and survival rates were not significantly different from those of young women treated in the 1960s. Comparison of Stage II patients treated in 1964 to 1970 with postoperative radiotherapy with comparable women given adjuvant chemotherapy from 1976 to 1979 revealed no significant difference in disease-free survival in the first 3 years after surgery. It remains to be seen whether these changes in therapy will diminish the frequency of recurrences after 5 years, leading to an improvement in overall survival. When compared with historical controls from this and other institutions, the 5-year and 10-year survival rates of approximately 75% and 60%, respectively, found in this study of young women with primary operative disease were not appreciably different from those of women treated for breast cancer at a later age when the disease is more common.

Prognostic factors in breast cancer

Data relating to 1022 patients with early breast cancer who were entered into a clinical trial have been analysed to assess the importance of various factors in predicting prognosis. Clinical stage was the major determinant of prognosis, and in each stage patients with a breast tumour 2 cm or less in maximum diameter had a significantly better survival than patients with larger tumours. Patients aged between 40 and 49 years and premenopausal patients had relatively favourable prognosis. Site of the tumour within the breast, whether it was situated on the left or the right side, the patient's martial status and the number of pregnancies did not appear to have any influence.

Survival following breast cancer surgery in the elderly

A retrospective analysis was performed on a series of 780 patients with breast cancer who underwent surgery, with emphasis on survival in the 138 patients over 70 years of age (elderly group). Absolute survival rates were determined using life table methods. Relative survival figures were derived from absolute figures by adjusting for expected longevity in each group. Patients over 70 years of age had overall 5 and 10 year absolute survival rates of 54% and 41%, respectively, which did not differ significantly from survival rates of younger patients. Relative five-year survival rates for the elderly were actually higher than those of younger patients, being 90% for those with local disease and 65% for those with regional disease. Survival in the elderly was comparable to that of younger patients, irrespective of race, type of surgery, histology or tumor size. These findings support the conclusion that there is little justification for avoiding conventional operative treatment in elderly patients with breast cancer solely on the basis of advanced age.

Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer

Two hundred thirty-seven patients with cancer of the breast treated with radical mastectomy were reviewed. Coefficients of correlation between patient's and doctor's delay vs. survival were not significant at p smaller than 0.05. No significant relationship between delay and time of recurrence was found.

Management of breast cancer in old age

In a retrospective survey of 301 women aged over 70 with breast cancer the factors affectingfive-year survival are evaluated. The local disease is more advanced when the patient presents with it in old age than in younger women, possibly associated with a lesser degree of awareness or a long history of the primary tumour. It is not associated with a different average rate of tumour growth in old age, as measured by scar recurrences after surgery. Radical surgery may be followed by a high five-year survival rate in patients carefully selected on medical grounds, but in this unselected series the five-year survival rate was practically the same whether the local disease was limited or extensive at presentation and whatever the treatment given. The probability of five-year survival in a woman over 70 with breast cancer will depend mainly on her general health.