TY - JOUR
T1 - Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence
T2 - A Tamoxifen Exemestane Adjuvant Multinational Study Analysis
AU - van de Water, Willemien
AU - Seynaeve, Caroline
AU - Bastiaannet, Esther
AU - Markopoulos, Christos
AU - Jones, Steve E.
AU - Rea, Daniel
AU - Hasenburg, Annette
AU - Putter, Hein
AU - Hille, Elysée T.M.
AU - Paridaens, Robert
AU - de Craen, Anton J.M.
AU - Westendorp, Rudi G.J.
AU - van de Velde, Cornelis J.H.
AU - Liefers, Gerrit Jan
PY - 2013/2/1
Y1 - 2013/2/1
N2 - 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.
AB - 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.
KW - Breast cancer
KW - Elderly
KW - Hormone receptor positive
KW - Outcome
KW - Recurrence
UR - http://www.scopus.com/inward/record.url?scp=84873038287&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2012-0315
DO - 10.1634/theoncologist.2012-0315
M3 - Article
C2 - 23263290
AN - SCOPUS:84873038287
SN - 1083-7159
VL - 18
SP - 8
EP - 13
JO - Oncologist
JF - Oncologist
IS - 1
ER -