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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Current Geriatrics Reports
Published in: Current Geriatrics Reports 4/2017

Open Access 01-12-2017 | Hematology and Oncology (GR Williams, Section Editor)

Primary Endocrine Therapy in Older Women with Breast Cancer

Authors: R. M. C. Pepping, J. E. A. Portielje, W. van de Water, N. A. de Glas

Published in: Current Geriatrics Reports | Issue 4/2017

Login to get access

Abstract

Purpose of Review

Breast cancer incidence increases with age. In recent years, primary endocrine therapy has been increasingly used as a treatment option for frail elderly women with breast cancer, although surgery is still the guideline-recommended treatment. In this review, we discuss the evidence for primary endocrine therapy versus surgical treatment in older women with early breast cancer.

Recent Findings

Both randomised controlled trials and recent observational studies showed a favourable progression-free survival but not overall survival for surgery plus adjuvant endocrine therapy versus primary endocrine therapy. Information about quality of life with either treatment strategy is so far lacking. Deciding who is fit for surgery and has sufficiently long life expectation to be at risk of disease progression can be supported by performing an individual geriatric assessment.

Summary

This review suggests that primary endocrine therapy is a reasonable alternative to primary surgery in frail older women with breast cancer. Future studies should focus on the long-term effects on quality of life and physical functioning.
Literature
1.
DeSantis CMJ, Bryan L, Jemal A. Breast cancer statistics 2013. CA Cancer J Clin. 2014;64(1):52–62.CrossRefPubMed
2.
Kiderlen M, de Glas NA, Bastiaannet E, van de Water W, de Craen AJ, Guicherit OR, et al. Impact of comorbidity on outcome of older breast cancer patients: a FOCUS cohort study. Breast Cancer Res Treat. 2014;145(1):185–92.CrossRefPubMed
3.
• de Glas NA, Kiderlen M, Vandenbroucke JP, de Craen AJ, Portielje JE, van de Velde CJ, et al. Performing survival analyses in the presence of competing risks: a clinical example in older breast cancer patients. J Natl Cancer Inst. 2016;108(5). Showing the importance of including competing mortality in studies in elderly women with breast cancer.
4.
Gaskell DJ, Hawkins RA, De Carteret S, Chetty U, Sangster K, Forrest APM. Indications for primary tamoxifen therapy in elderly women with breast cancer. Br J Surg. 1992;79(12):1317–20.CrossRefPubMed
5.
6.
Cheung KL, Wong AW, Parker H, Li VW, Winterbottom L, Morgan DA, et al. Pathological features of primary breast cancer in the elderly based on needle core biopsies—a large series from a single centre. Crit Rev Oncol Hematol. 2008;67(3):263–7.CrossRefPubMed
7.
•• Biganzoli LWH, Oakman C, Marotti L, Loibl S, Kunkler I, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). The Lancet Oncology. 2012;13(4):148–60. Revised guideline recommendations concerning treatment of older women with breast cancer. CrossRef
8.
Wildiers HKI, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. The Lancet Oncology. 2007;8(12):1101–15.CrossRefPubMed
9.
Zulman DMSJ, Chen X, Cigolle CT, Blaum CS, Ra H. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26(7):783–90.CrossRefPubMedPubMedCentral
10.
•• van de Water WKM, Bastiaannet E, Siesling S, Westendorp RG, van de Velde CJ, et al. External validity of a trial comprised of elderly patients with hormone receptor-positive breast cancer. J Natl Cancer Inst. 2014;106(4):dju051. Showing the importance and relevance of GA in older adults in the oncology setting. CrossRefPubMed
11.
Puts MTHJ, Monette J, Girre V, Springall E, Alibhai SM. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J Natl Cancer Inst. 2012;104(15):1133–63.CrossRefPubMed
12.
•• Hind DWL, Reed MW. Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. Br J Cancer. 2007;96(7):1025–9. Meta-analyses that included all randomised trials on PET versus surgery in elderly women with breast cancer. CrossRefPubMedPubMedCentral
13.
Fentiman IS, Christiaens MR, Paridaens R, Van Geel A, Rutgers E, Berner J, et al. Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomy. Eur J Cancer. 2003;39(3):309–16.CrossRefPubMed
14.
Kenny FS, JFR R, Ellis I, Elston CW, Blarney RW. Long-term follow-up of elderly patients randomized to primary tamoxifen or wedge mastectomy as initial therapy for operable breast cancer. Breast. 1998;7:335–9.CrossRef
15.
Gazet JC, Ford HT, Coombes RC, Bland JM, Sutcliffe R, Quilliam J, et al. Prospective randomized trial of tamoxifen vs surgery in elderly patients with breast cancer. European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 1994;20(3):207–14.
16.
Gazet JC, Sutcliffe R. A randomised trial comparing tamoxifen vs. surgery in patients over the age of 70 with operable breast cancer—final results after 28 years of follow-up. European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2011;37(9):754–7.CrossRef
17.
Willsher PC, JFR R, Jackson L, Al-Hilaly M, Blarney RW. Investigation of primary tamoxifen therapy for elderly patients with operable breast cancer. Breast. 1997;6:150–4.CrossRef
18.
Mustacchi G, Milani S, Pluchinotta A, De Matteis A, Rubagotti A, Perrota A. Tamoxifen or surgery plus tamoxifen as primary treatment for elderly patients with operable breast cancer: the G.R.E.T.A. Trial. Anticancer Res. 1994;14:2197–200.PubMed
19.
Mustacchi G, Ceccherini R, Milani S, Pluchinotta A, De Matteis A, Maiorino L, et al. Tamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial. Annals of Oncology : Official Journal of the European Society for Medical Oncology. 2003;14(3):414–20.CrossRef
20.
Fennessy M, Bates T, MacRae K, Riley D, Houghton J, Baum M. Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer. Br J Surg. 2004;91(6):699–704.CrossRefPubMed
21.
Johnston SJ, Kenny FS, Syed BM, Robertson JF, Pinder SE, Winterbottom L, et al. A randomised trial of primary tamoxifen versus mastectomy plus adjuvant tamoxifen in fit elderly women with invasive breast carcinoma of high oestrogen receptor content: long-term results at 20 years of follow-up. Annals of Oncology : Official Journal of the European Society for Medical Oncology. 2012;23(9):2296–300.CrossRef
22.
Wink CJ, Woensdregt K, Nieuwenhuijzen GAP, van der Sangen MJC, Hutschemaekers S, Roukema JA, et al. Hormone treatment without surgery for patients aged 75 years or older with operable breast cancer. Ann Surg Oncol. 2012;19(4):1185–91.CrossRefPubMed
23.
Hille U, Soergel P, Länger F, Schippert C, Makowski L, Hillemanns P. Aromatase inhibitors as solely treatment in postmenopausal breast cancer patients. Breast J. 2012;18(2):145–50.CrossRefPubMed
24.
Quiroga-García V, Cirauqui-Cirauqui B, Bugés-Sánchez C, Luna-Tomás MÁ, Castellà-Fernández EM, Mariscal-Martínez A, et al. Primary hormone therapy in elderly women with hormone-sensitive locoregional breast cancer: endocrine therapy alone is a reasonable alternative in selected patients. Breast Care. 2015;10(3):179–83.CrossRefPubMedPubMedCentral
25.
• Morgan J, Richards P, Ward S, Francis M, Lawrence G, Collins K, et al. Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer. Br J Surg. 2015;102(9):1056–63. Example of observational study that demonstrates selection bias. CrossRefPubMed
26.
• de Glas NA, Kiderlen M, de Craen AJ, Hamaker ME, Portielje JE, van de Velde CJ, et al. Assessing treatment effects in older breast cancer patients: systematic review of observational research methods. Cancer Treat Rev. 2015;41(3):254–61. Showing the difficulty in assessing treatment effects with observational study methods and discusses the subject of confounding by indication. CrossRefPubMed
27.
• Cortadellas T, Córdoba O, Gascón A, Haladjian C, Bernabeu A, Alcalde A, et al. Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution. European Journal of Surgical Oncology (EJSO). 2015;41(5):635–40. Showed a significant better overall survival for surgical treatment, but only in certain early stages of breast cancer. CrossRef
28.
Cortadellas T, Gascón A, Córdoba O, Rabasa J, Rodríguez R, Espinosa-Bravo M, et al. Surgery improves breast cancer-specific survival in octogenarians with early-stage breast cancer. Int J Surg. 2013;11(7):554–7.CrossRefPubMed
29.
• Kantor O, Pesce C, Liederbach E, Wang C-H, Winchester DJ, Yao K. Surgery and hormone therapy trends in octogenarians with invasive breast cancer. Am J Surg. 2016;211(3):541–5. Showing a strong increase of the percentage of patients who received PET in a large cohort over a decade. CrossRefPubMed
30.
•• Hamaker ME, Bastiaannet E, Evers D, Water W, Smorenburg CH, Maartense E, et al. Omission of surgery in elderly patients with early stage breast cancer. Eur J Cancer. 2013;49(3):545–52. Showing a large increase in the use of PET in the Netherlands, while no difference in overall survival was observed. CrossRefPubMed
31.
•• de Glas NA, Jonker JM, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, et al. Impact of omission of surgery on survival of older patients with breast cancer. Br J Surg. 2014;101(11):1397–404. Showing a large increase in the use of PET in the Netherlands, while no difference in overall survival was observed. CrossRefPubMed
32.
•• de Glas NAKM, Bastiaannet E, de Craen AJ, van de Water W, van de Velde CJ, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat. 2013;138(2):561–9. Showed that the incidence of complications of surgical treatment in women with breast cancer increases with age. CrossRefPubMed
33.
Chatzidaki PMC, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol. 2011;18(4):923–31.CrossRefPubMed
34.
35.
van de Water W, Bastiaannet E, Hille ET, Meershoek-Klein Kranenbarg EM, Putter H, Seynaeve CM, et al. Age-specific nonpersistence of endocrine therapy in postmenopausal patients diagnosed with hormone receptor-positive breast cancer: a TEAM study analysis. Oncologist. 2012;17(1):55–63.CrossRefPubMed
36.
Demissie S, Silliman RA, Lash TL. Adjuvant tamoxifen: predictors of use, side effects, and discontinuation in older women. J Clin Oncol. 2001;19(2):322–8.CrossRefPubMed
37.
38.
• Burton M, Collins KA, Lifford KJ, Brain K, Wyld L, Caldon L, et al. The information and decision support needs of older women (>75 yrs) facing treatment choices for breast cancer: a qualitative study. Psycho-Oncology. 2015;24(8):878–84. More and more treatments are based on patients’ choice, with elderly being a heterogenous patient category. CrossRefPubMed
39.
Wylie S, Ravichandran D. A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer. Ann R Coll Surg Engl. 2013;95(5):353–6.CrossRefPubMedPubMedCentral
40.
Girre V, Falcou MC, Gisselbrecht M, Gridel G, Mosseri V, Bouleuc C, et al. Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients? J Gerontol A Biol Sci Med Sci. 2008;63(7):724–30.CrossRefPubMed
41.
Chaibi P, Magne N, Breton S, Chebib A, Watson S, Duron JJ, et al. Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol Hematol. 2011;79(3):302–7.CrossRefPubMed
42.
Kenis C, Bron D, Libert Y, Decoster L, Van Puyvelde K, Scalliet P, et al. Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Annals of Oncology : Official Journal of the European Society for Medical Oncology. 2013;24(5):1306–12.CrossRef
43.
Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, et al. EORTC elderly task force position paper: approach to the older cancer patient. European Journal of Cancer (Oxford, England:1990). 2010;46(9):1502–13.CrossRef
Metadata
Title
Primary Endocrine Therapy in Older Women with Breast Cancer
Authors
R. M. C. Pepping
J. E. A. Portielje
W. van de Water
N. A. de Glas
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 4/2017
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-017-0223-z

Other articles of this Issue 4/2017

Current Geriatrics Reports 4/2017 Go to the issue

Hematology and Oncology (GR Williams, Section Editor)

Polypharmacy in Older Adults with Cancer: Evaluating Polypharmacy as Part of the Geriatric Assessment

Cardiovascular Disease in the Elderly (M Chen, Section Editor)

Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients

Hematology and Oncology (GR Williams, Section Editor)

Assessing Frailty and Vulnerability in Older Adults with Cancer

Hematology and Oncology (GR Williams, Section Editor)

Comorbidity, Physical Function, and Quality of Life in Older Adults with Acute Myeloid Leukemia

Cardiovascular Disease in the Elderly (M Chen, Section Editor)

Care of the Elderly Patient with Infective Endocarditis

Hematology and Oncology (GR Williams, Section Editor)

Sarcopenia in Oncology or Gerontology: What Is the Difference?

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits