Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: A Tamoxifen Exemestane Adjuvant Multinational Study Analysis

Research output: Contribution to journalArticlepeer-review


  • Willemien van de Water
  • Caroline Seynaeve
  • Esther Bastiaannet
  • Christos Markopoulos
  • Steve E. Jones
  • Annette Hasenburg
  • Hein Putter
  • Elysée T.M. Hille
  • Robert Paridaens
  • Anton J.M. de Craen
  • Rudi G.J. Westendorp
  • Cornelis J.H. van de Velde
  • Gerrit Jan Liefers

Colleges, School and Institutes

External organisations

  • Leiden University Medical Center - LUMC
  • Erasmus MC
  • Athens University
  • US Oncology Research
  • University Hospital
  • Leuven Cancer Institute


Introduction. For postmenopausal patients with hormonesensitive breast cancer, outcome is worse with increasing age at diagnosis. The aim of this study was to assess the incidenceof breast cancer recurrence (locoregionalanddistant), and contralateral breast cancer by age at diagnosis. Methods. Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial were included. Primary endpoints were locoregional recurrence, distant recurrence, and contralateralbreastcancer.Ageatdiagnosiswascategorizedas younger than 65 years, 65-74 years, and 75 years or older. Results. Overall, 9,766 patients were included, of which 5,349 were younger than 65 years (reference group), 3,060 were 65-74 years, and 1,357 were 75 years or older. With increasing age, a decreased administration of radiotherapy after breast conserving surgery (94%, 92%, and 88%, respectively) and adjuvant chemotherapy (51%, 23%, and 5%, respectively) was observed. Risk of distant recurrence increased with age at diagnosis; multivariable hazard ratio for patients aged 65-74 years was 1.20 (95% confidence interval [CI]: 1.00 -1.44), hazard ratio for patients aged 75 years or older was 1.39 (95% CI: 1.08 -1.79). Risks of locoregional recurrence and contralateral breast cancer were not significantly different across age groups. Conclusion. Elderly patients with breast cancer were at increased risk for distant recurrence. Other studies have shown that the risk of distant recurrence is mainly affected by adjuvant systemic therapy. All TEAM patients received adjuvant endocrine treatment; however, chemotherapy was administered less often in elderly patients. These findings are suggestive for consideration of chemotherapy in relatively fit elderly breast cancer patients with hormonesensitive disease.


Original languageEnglish
Pages (from-to)8-13
Number of pages6
Issue number1
Publication statusPublished - 1 Feb 2013


  • Breast cancer, Elderly, Hormone receptor positive, Outcome, Recurrence

ASJC Scopus subject areas

Sustainable Development Goals