How do we manage breast cancer in the elderly patients? A survey among members of the British Association of Surgical Oncologists (BASO)

Aims: To frame the attitude and perception of breast surgeons in the UK toward the increasing number of older breast cancer patients. Methods: A 15-item questionnaire was designed to inquire on the definition of elderly, clinical management, age-related differences in surgical treatment, interaction with geriatricians, operative risk assessment, and surveyed identification/descriptive data. The questionnaire was sent to all 350 ABS associates (Association of Breast Surgery) at the British Association of Surgical Oncology (BASO). Results: A 150 questionnaires were returned (compliance 43%) providing the largest sample of breast surgical specialist overview on this topic. The major part of the surveyed (44%) stated age does not stand as the most relevant factor on its own in identifying a patient as "elderly", nor in offering surgical management (98%) and in dealing with the axilla (75%). The surveyed are aware of the burden of this epidemiological problem and would rather finalise the decision-making process based on multiple factors. This is to tailor the most appropriate treatment aiming to improving quality of life (42%) and quality adjusted survival (40%). Although most breast surgeons are inclined to discuss their onco-geriatric patients with geriatricians on a regular (32%) or occasional (42%) basis, no geriatric assessment is routinely utilised (82%) and the operative risk is predicted with ASA (45%). These figures confirm the surveyed breast surgeons in the UK are not biased by an ageistic approach, and aim to achieve a global well-being to the older patients with breast cancer. Conclusions: This survey confirms our lack of knowledge in the management of elderly patients affected by breast cancer. Taken into account the limitations of a survey, we are pleased to confirm the performance of the largest part of breast surgeons at BASO is not biased by an ageist mentality. (C) 2004 Elsevier Ireland Ltd. All rights reserved.