Outcomes After Mastectomy and Lumpectomy in Elderly Patients with Early-Stage Breast Cancer

Survival in elderly patients undergoing mastectomy or lumpectomy has not been specifically analyzed.

Patients older than 70 years of age with clinical stage I invasive breast cancer, undergoing mastectomy or lumpectomy with or without radiation, and surveyed within 3 years of their diagnosis, were identified from the Surveillance, Epidemiology, and End Results and medicare health outcomes survey-linked dataset. The primary endpoint was breast cancer-specific survival (CSS).

Of 1784 patients, 596 (33.4 %) underwent mastectomy, 918 (51.4 %) underwent lumpectomy with radiation, and 270 (15.1 %) underwent lumpectomy alone. Significant differences were noted in age, tumor size, American Joint Committee on Cancer (AJCC) stage, lymph node status (all p < 0.0001) and number of positive lymph nodes between the three groups (p = 0.003). On univariate analysis, CSS for patients undergoing lumpectomy with radiation [hazard ratio (HR) 0.61, 95 % confidence interval (CI) 0.43–0.85; p = 0.004] was superior to mastectomy. Older age (HR 1.3, 95 % CI 1.09–1.45; p = 0.002), two or more comorbidities (HR 1.57, 95 % CI 1.08–2.26; p = 0.02), inability to perform more than two activities of daily living (HR 1.61, 95 % CI 1.06–2.44; p = 0.03), larger tumor size (HR 2.36, 95 % CI 1.85–3.02; p < 0.0001), and positive lymph nodes (HR 2.83, 95 % CI 1.98–4.04; p < 0.0001) were associated with worse CSS. On multivariate analysis, larger tumor size (HR 1.89, 95 % CI 1.37–2.57; p < 0.0001) and positive lymph node status (HR 1.99, 95 % CI 1.36–2.9; p = 0.0004) independently predicted worse survival.

Elderly patients with early-stage invasive breast cancer undergoing breast conservation have better CSS than those undergoing mastectomy. After adjusting for comorbidities and functional status, survival is dependent on tumor-specific variables. Determination of lymph node status remains important in staging elderly breast cancer patients.