Ward SE, et al. - Researchers compared breast cancer-specific survival (BCSS) in older women who were treated with surgery vs primary endocrine therapy. Findings revealed that not using surgery in older women with estrogen receptor (ER)-positive disease resulted in worse BCSS and may play a part in poorer cancer outcomes. Identification of women who derive little benefit from surgical treatment may be possible by opting for surgery based on predicted life expectancy.

Methods

• For this study, researchers gathered cancer registration data for 2002–2010 from two English regions.
• They performed retrospective analysis using women with estrogen receptor (ER)-positive disease.
• They used statistical modelling to demonstrate the impact of treatment (surgery or primary endocrine therapy) and age and health status on BCSS.
• They used multiple imputation to handle missing data.

Results

• They obtained cancer registration data on 23,961 women.
• After data preprocessing, ER-positive disease was found to be present in 18,730 of 23,849 women (78.5 per cent); of these, 10,087 (53.9 per cent) underwent surgery and 8,643 (46.1 per cent) received primary endocrine therapy.
• The primary endocrine therapy group vs the surgical group had worse BCSS (5-year BCSS rate 69.4 and 89.9 per cent respectively).
• Though the difference was less in the cohort with the greatest degree of co-morbidity, this was true for all strata considered.
• A less relative influence of the hazard of breast cancer death on overall survival was reported for older, frailer patients.