Clinical Decision-Making in Elderly Women With Early-Stage Breast Cancer: A UK Perspective

By: Joshua D. Madera, MD
Posted: Friday, February 9, 2024

Given the increased incidence of mastectomy in older women with early-stage invasive breast carcinoma, investigative efforts have been dedicated to determining the reasoning behind this clinical management strategy, according to a UK study published in the Journal of Geriatric Oncology. The lack of a significant association with tumor characteristics or physical fitness questions the inconsistencies in surgical decision-making and may require additional research efforts to elucidate the overall logic behind these decisions, suggested Katie Miller, MPhil, PhD, of the Royal College of Surgeons of England, London, and colleagues.

From 2014 to 2019, a total of 106,952 women with early-stage invasive breast carcinoma were recruited for the study. All women were stratified based on their age as younger (aged 50–69) or older (aged 70 and older). Patients were additionally stratified based on their tumor stage (T1, T2, or T3). All patients had a mastectomy as the treatment for their disease.

Rates of mastectomy were increased in women who were diagnosed with more advanced disease (12.3% for T1, 37.6% for T2, 77.5% for T3). When stratification by age was included, older women—regardless of their tumor stage—were more likely to receive mastectomy (11.8% for women aged 50–59 vs 26.3% for women aged 80 and older with T1 disease; 31.5% vs 56.9% for T2 disease; 73.4% vs 90.3% for T3 disease, respectively). Moreover, women who were considered severely frail were more likely to have a mastectomy if they had T1 or T2 disease. However, no differences were observed for women with T3 disease.  

“Evidence from qualitative research on the perceptions of both older patients and surgeons on types of breast surgery would provide a clearer framework for decision making, which could help to reduce barriers to breast conservation among older patients with breast cancer,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit geriatriconcology.net.

Journal of Geriatric Oncology

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