Abstract P2-18-17: Breast cancer surgery for the elderly - Are we meeting a growing need?
Authors: Olsen SB , Davies M , Cameron D , Cook L , Dunn J 
Published: August 2014

Background≤br≥Between 2002 and 2011, in the UK, the number of people aged 90 increased by 26%. By 2034 the number of people aged 85 and over, is projected to be 2.5 times larger than in 2009. Life expectancy of 80 year old woman is now 9.4 years.

These population statistics bring challenges to the provision of healthcare in general and Breast Cancer Services will see a significant increase in the number of very elderly patients.

Prior to 2009 it was common place to treat patients aged over 80 with endocrine therapy alone, avoiding surgery, however as the general life expectancy for this age group has improved this is no longer recommended management.

NICE guidelines issued in February 2009 recommend surgery for breast cancer where possible over endocrine treatment

We aim to review the proportion of patients presenting with breast cancer aged over 80, assess their management and survival during a 12 year period and audit patients presenting after 2009 against NICE guideline to explore reasons for noncompliance.

Methods

We have conducted a retrospective audit of all patients presenting with breast cancer to a single high-volume center from 2000-2012.

Patients were identified from a comprehensive departmental database recording patient demographics as well as treatment modality.

For patients treated after 2009, case records were accessed to assess the reasons for omitting surgery.

One-tailed Fisher's Exact Test used throughout to calculate p-values.

Results≤br≥5446 patients were treated at our unit from 2000-2012 with the over 80's comprising 6.0-8.7% p.a.

This age group increased over time by 29% from 6.5% in 2000-2003 to 8.4% (p = 0.0001) in 2009-2012. The population aged 90 or over increased by around 50% from 1.7% to 2.6% (p = 0.06) in the same period.

The table below shows changes in the proportion of patients offered surgery before and after the 2009 guidelines.

Patients Undergoing Breast Cancer SurgeryPatients aged 80-89Patients aged 90 and over2000- 20082009-2012p-value2000-20082009-2012p-value267/396 (67%)172/230 (75%)0.0318/64 (28%)21/47 (44%)0.05

Following introduction of regional anaesthesia without General Anasthesia in 2011, the proportion of patients aged over 90 having surgery, increased further to 16/25 (64% p-0.0031).

In the 10 year period from 2001-2010 the mastectomy rate was 60% in the over 80's and 45% in the over 90 year old, however this difference was not statistically significant (p = 0.29).

We have accurate survival data for 396 patients who died during follow up. No patients died within 12 months of surgery. The median survival was 40 months following surgery and 27 months for patients treated with primary endocrine therapy.

16/218 patients aged 80-89 and 2/111 patients aged over 90 at diagnosis required resectional surgery after relapse on primary endocrine therapy.

Of patients not having surgery after 2009, 48 were deemed unfit and 36 declined surgery.

Conclusions≤br≥The elderly is a growing part of our population of breast cancer patients.

We have increased the proportion of elderly patient having surgery in line with NICE guidance, partly due regional anaesthesia for breast surgery and modification of care pathways. The relapse rate following primary endocrine therapy was very low in the most elderly patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-17.