Abstract P3-10-08: Breast cancer in octogenarians: Presentation and treatment affect mortality
Authors: Wilson JP , Gadiyaram V , Blumencranz PW 
Published: February 2018

Background: Breast cancer incidence increases in age. Unfortunately, elderly patients are often under-treated and under-diagnosed affecting their overall survival with limited availability of clinical trial data.

Patients and Methods: We used data from our cancer registry and our state cancer registry to evaluate cases of breast cancer diagnosed between the years 2005 and 2010 with follow up data available to date to examine the method of diagnosis (mammogram vs. palpable abnormality), age at diagnosis, stage at diagnosis, type of surgery, receptor status, treatment received, and survival. We then were able to use our state database which contained data regarding causality of death. Based on the data available we were able to evaluate the impact of the method of diagnosis and treatment on patient mortality.

Results: A total of 495 octogenerian breast cancer patients were diagnosed between 2005 and 2010. The median age at diagnosis was 85 with a range of 81-102. Out of the 495 patients 55% were diagnosed with a mammogram and 41% by palpable abnormality. The patients who presented with a palpable mass were more likely to die of breast cancer (26%) than the patients who presented with a screening abnormality (9%). The patients with a screening abnormality also had a longer survival (30.0 month) among patients who died from breast cancer as opposed to those who presented with a palpable abnormality who died from breast cancer (16.7 months). While the number of patients dying from other causes was similar (65% screened vs. palpable) the patients with palpable findings had a shorter survival (30.5 months) compared to those detected by screening (48.9 months).

Table 1: Comparison of outcomes between screen detected and physical exam detected breast cancer patientsOutcomeScreenedPalpableDied of Breast Cancer9% (30.0 months)26% (16.7 months)Died of Other Causes65% (48.9 months)60% (30.5 months)Still Alive25.6% (66.9 months)10% (51.0 months)

There was an improvement in survival among patients who presented with a palpable mass and were treated with endocrine therapy (17.3 vs 11%). This improvement did not extend to the screened population (24.3% vs 29%), although the patients who died from breast cancer had an overall longer survival (35.4 months vs 27.3 months). There was also an improvement in survival among patients who received radiation therapy in both the screened (33% vs. 22%) and palpable (22.5% vs 11.1%) groups. Only 6% of patients in the entire study received chemotherapy.

Effect of presentation and treatment on survivalModalityScreened/TreatedPalpable/TreatedScreened/ No TreatmentPalpable/No TreatmentRadiation33% (29.6 months)22.5% (10 months)22% (27 months)11.1% (20 months)Endocrine24.3% (35.4 months)17.3% (15.7 months)29% (27.3 months)11% (18.5 months)

Conclusion: Our data support continued use of screening mammography in patients who are at good surgical risk into their 80's. The patients who were diagnosed with symptoms fared worse than the patients who had their cancer discovered on routine imaging. There was an improvement in patients who were treated with adjuvant endocrine and radiation therapy although the rationale behind providing or excluding treatment cannot be discerned from this retrospective registry study.

Citation Format: Wilson JP, Gadiyaram V, Blumencranz PW. Breast cancer in octogenarians: Presentation and treatment affect mortality [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-08.