Breast cancer in octogenarians

BACKGROUND. The number of older cancer patients has increased in recent years. Guidelines for their care are often lacking. Data on the natural course of breast cancer and outcome of therapy in this population are needed. METHODS. The authors undertook a retrospective chart review with complete follow-up of 135 women diagnosed with localized breast cancer at age 80 years or older, who received standard or less than standard local treatment in 2 tertiary centers in Israel between 1991 and 2001. RESULTS. Median age at diagnosis was 83 years. In 60 (44%) patients, initial local treatment consisted of modified radical mastectomy or lumpectomy and axillary dissection followed by radiation therapy [standard local treatment (SLT)]; 75 (56%) patients received less than SLT. Tumors were stage T1-T2 in 90% of cases, 76% of the tumors were hormone-sensitive. Infiltrating duct carcinoma predominated (90 cases), mostly (80 of 90) Grade 2-3. Lymph node metastases were detected in 32 of 73 (44%) patients who underwent axillary lymph node dissection. At a median of 70 months after diagnosis, 18 (13%) patients had disease recurrence, and 34 (25%) had died. Axillary failures were detected only in the less-than-SLT group. This did not indicate worse overall or disease-specific survival. CONCLUSION. Most breast cancer octogenarians in this series lived > 6 years after diagnosis. These data do not support the assumption that breast tumors are histologically more indolent in elderly patients. Less than SLT can be applied to this patient group with somewhat increased axillary failure rates that may be addressed upfront by the sentinel node technique.