Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2013

01-10-2013 | Breast Oncology

Hormone Receptor-Negative Breast Cancer: Undertreatment of Patients Over 80

Authors: Anna Weiss, MD, Abraham Noorbaksh, BA, Christopher Tokin, MD, David Chang, PhD, MPH, MBA, Sarah L. Blair, MD

Published in: Annals of Surgical Oncology | Issue 10/2013

Login to get access

Abstract

Purpose

Patients older than 80 years represent a significant breast cancer population but are underrepresented in clinical trials. It is established that estrogen receptor (ER)/progesterone receptor (PR)-negative status confers a worse prognosis in patients under 70, but this is not well studied in those over 80. We examined the prognosis of patients over 80 with ER/PR-negative disease to determine whether these patients are more likely to die of breast cancer than cardiovascular disease and to study treatment patterns.

Methods

We queried the Surveillance Epidemiology and End Results (SEER) database between 1992 and 2009 for patients with invasive breast carcinoma. Primary outcomes were breast cancer or cardiovascular death; secondary outcomes were radiotherapy and surgery. Cox proportional hazard analysis and logistic regression were used to determine adjusted outcomes over time. Subset analysis was performed comparing mortality rates by stage.

Results

There were 502,807 patients, 6,933 over 80 with ER/PR-negative disease. ER/PR-negative patients over 80 faced decreased 10-year survival compared to ER/PR-positive patients (61.5, 81.4 %; p < 0.05). ER/PR-negative patients were more likely to die of breast cancer than of cardiovascular disease (25.6, 12.2 %). Adjusting for confounders, ER/PR-negative patients over 80 were more likely to die from breast cancer specifically than patients aged 50–79 years [hazards ratio (HR) 1.53, 95 % confidence interval (CI) 1.43–1.64]. This finding was consistent across all stages. Compared to younger cohorts, elderly patients with ER/PR-negative disease received less radiotherapy [odds ratio (OR) 0.42, 95 % CI 0.39–0.46] and had a trend for less surgery (OR 0.86, 95 % CI 0.69–1.07).

Conclusions

Elderly ER/PR-negative patients are more likely to die of their breast disease than cardiovascular disease. Standard treatment regimens, especially radiotherapy, should be considered for elderly patients.
Literature
1.
Louwman WJ, Vulto JCM, Verhoeven RHA, Nieuwenhuijzen GAP, Coebergh JWW, Voogd AC. Clinical epidemiology of breast cancer in the elderly. Eur J Cancer. 2007;43:2242–52.PubMedCrossRef
2.
Wildiers H, Kunkler I, Biganzoli L, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8:1101–15.PubMedCrossRef
3.
Colzani E, Liljegren A, Johannson ALV, et al. Prognosis of patients with breast cancer: causes of death and effects of time since diagnosis, age, and tumor characteristics. J Clin Oncol. 2011;29:4014–21.PubMedCrossRef
4.
Lewis JH, Kilgore ML, Goldman DP, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–9.PubMedCrossRef
5.
Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.PubMedCrossRef
6.
Eaker S, Dickman PW, Bergkvist L, Holmberg L. Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden. PLOS Med. 2006;3:321–8.CrossRef
7.
Dragun AE, Huang B, Tucker TC, Spanos WJ. Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival. Cancer. 2011;117:2590–8.PubMedCrossRef
8.
Velanovich V, Gabel M, Walker EM, et al. Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients. J Am Coll Surg. 2002;194:8–13.PubMedCrossRef
9.
Bouchardy C, Rapiti E, Fioretta G, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.PubMedCrossRef
10.
Louwman WJ, Janssen-Heijnen MLG, Houterman S, et al. Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer. 2005;41:779–85.PubMedCrossRef
11.
12.
Gajdos C, Tartter PI, Bleiweiss IJ, Lopchinsky RA, Bernstein JL. The consequence of undertreating breast cancer in the elderly. J Am Coll Surg. 2001;192:698–707.PubMedCrossRef
13.
14.
Van de Water W, Bastiaannet E, Dekkers OM, et al. Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis. Br J Surgery. 2012;99:813–20.CrossRef
15.
Bastiaannet E, Liefers GJ, de Craen AJM, et al. Breast cancer in elderly compared to younger patients in the netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124:801–7.PubMedCrossRef
16.
Van Leeuwen BL, Rosenkranz KM, Feng LL, et al. The effect of under-treatment of breast cancer in women 80 years of age and older. Crit Rev Oncol Hematol. 2011;79:315–20.PubMedCrossRef
17.
Jansse-Heijnen MLG, Houterman S, Lemmens VEPP, Louwman MWJ, Maas HAAM, Coebergh JWW. Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol. 2005;55:231–40.CrossRef
18.
Falkson CI, Falkson G, Falkson HC. Postmenopausal breast cancer: drug therapy in the 1990s. Drugs Aging. 1993;3:106–21.PubMedCrossRef
19.
Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–17.
20.
Berry DA, Cirrincione C, Henderson IC, et al. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA. 2006;295:1658–67.PubMedCentralPubMedCrossRef
21.
22.
Morabito A, Magnani E, Gion M, et al. Prognostic and predictive indicators in operable breast cancer. Clin Breast Cancer. 2003;3:381–90.PubMedCrossRef
23.
Dunnwald LK, Rossing MA, Li CI. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res. 2007;9:R6.PubMedCentralPubMedCrossRef
24.
Anderson WF, Chen BE, Jatoi I, Rosenberg PS. Effects of estrogen receptor expression and histopathology on annual hazard rates of death from breast cancer. Breast Cancer Res Treat. 2006;100:121–6.PubMedCrossRef
25.
Yancik R, Wesley M, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285:885–92.PubMedCrossRef
26.
Shen X, Anne PR, Keith SW, et al. Radiation therapy use and outcomes among older women with ER-positive and ER-negative stage I breast cancer. Am J Clin Oncol. 2012;00:1–7.
27.
Reimer T, Gerber B. Quality of life considerations in the treatment of early-stage breast cancer in the elderly. Drugs Aging. 2010;27:791–800.PubMedCrossRef
28.
Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol. 2010;28:2038–45.PubMedCentralPubMedCrossRef
29.
Elkin EB, Hurria A, Mitra N, et al. Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol. 2006;24:2757–64.PubMedCrossRef
30.
Giordano SH, Duan Z, Kuo YF, et al. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol. 2006;24:2750–6.PubMedCrossRef
31.
Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9.PubMedCrossRef
32.
Jatoi I, Chen BE, Anderson WF, Rosenberg PS. Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol. 2007;25:1683–90.PubMedCrossRef
Metadata
Title
Hormone Receptor-Negative Breast Cancer: Undertreatment of Patients Over 80
Authors
Anna Weiss, MD
Abraham Noorbaksh, BA
Christopher Tokin, MD
David Chang, PhD, MPH, MBA
Sarah L. Blair, MD
Publication date
01-10-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3115-2

Other articles of this Issue 10/2013

Annals of Surgical Oncology 10/2013 Go to the issue

Breast Oncology

Shared Decision Making in Breast Cancer: National Practice Patterns of Surgeons

Breast Oncology

Treatment Efficacy with Accelerated Partial Breast Irradiation (APBI): Final Analysis of the American Society of Breast Surgeons MammoSite® Breast Brachytherapy Registry Trial

Breast Oncology

Axillary Reverse Mapping: A Prospective Study in Women with Clinically Node Negative and Node Positive Breast Cancer

Breast Oncology

Trends in Incidence and Management of Lobular Carcinoma In Situ: A Population-Based Analysis

Breast Oncology

Nipple Skin-Sparing Mastectomy is Feasible for Advanced Disease

Breast Oncology

The Value of 6-Month Interval Imaging after Benign Radiologic–Pathologic Concordant Minimally Invasive Breast Biopsy