WARD, S. E., RICHARDS, P. D., MORGAN, J. L., HOLMES, G. R., BROGGIO, J. W., COLLINS, Karen, REED, M. W. R. and WYLD, L. (2018). Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival. British Journal of Surgery, 105 (11), 1454-1463.
Documents
21345:504017
PDF
Collins-OmissionOfSurgeryInOlderWomen(AM).pdf - Accepted Version
Available under License All rights reserved.
Collins-OmissionOfSurgeryInOlderWomen(AM).pdf - Accepted Version
Available under License All rights reserved.
Download (554kB) | Preview
Abstract
Background: Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women
with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus
primary endocrine therapy on breast cancer-specific survival (BCSS) in older women.
Methods: Cancer registration data for 2002–2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical
modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health
status on BCSS. Missing data were handled using multiple imputation.
Results: Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of
23 849 women (78⋅5 per cent) were identified as having ER-positive disease; of these, 10 087 (53⋅9per
cent) had surgery and 8643 (46⋅1 per cent) had primary endocrine therapy. BCSS was worse in the primary
endocrine therapy group than in the surgical group (5-year BCSS rate 69⋅4and89⋅9 per cent respectively).
This was true for all strata considered, although the difference was less in the cohort with the greatest
degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact
on overall survival.
Conclusion: BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment
choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life
expectancy may permit choice of women for whom surgery confers little benefit.
More Information
Statistics
Downloads
Downloads per month over past year
Metrics
Altmetric Badge
Dimensions Badge
Share
Actions (login required)
![]() |
View Item |