Bridging the Age Gap in Breast Cancer - Analysis of the Complication Rates of Surgery in Older Women

Background: The Bridging the Age Gap in Breast Cancer study is a multicentre retrospective cohort study examining the management of older patients with breast cancer. This study aimed to examine the selection criteria for breast cancer surgery in patients over 70 and the adverse events risk in this population. We present the adverse event risks for breast cancer surgery in women over age 70 in the UK according to surgical type. Materials and Methods: Baseline information on patient characteristics, surgery type and adverse events was collected across 56 UK breast units. Surgery was classified as major (mastectomy or axillary node clearance) or minor surgery (breast conserving surgery +/- sentinel node biopsy). Adverse events were recorded for 2 years following surgery and classified using the Common Terminology for Classification of Adverse Events system and designated as systemic or local/wound complications. Rates of adverse events were calculated and compared between surgical categories using Chi Squared. Results: Between 2013-2018, 3460 women with operable breast cancer were recruited; 2792 (80.7%) were treated surgically. There were 62 bilateral tumours, giving a total of 2854 surgical events (1321 major, 1533 minor). There were no surgical related deaths (30-day mortality). The overall rate of systemic complications was 59/2854 (2.1%) and local complications was 1072/2854 (37.6%) although 547 had only a seroma and these have been excluded from further analysis. Major surgery was associated with higher rates of local complications (22.7%) vs minor (14.7%; P<0.01). Systemic complications (cardiorespiratory, CVA, embolic) were rare (major 2.9% vs minor 1.4%; p<0.01). Conclusions: Breast cancer surgery has a zero mortality rate in this large prospective UK series with acceptable rates of morbidity suggesting that it is safe in the 80% of older women selected as fit for surgery.