Breast cancer surgery in older women

  • Br J Surg
  • 3 Jun 2020

  • curated by Dawn O'Shea
  • UK Medical News
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Breast cancer surgery (BCS) is safe in women aged ≥70 years, according to the findings of the Bridging Age Gap in Breast Cancer study.

The prospective multicentre cohort study recruited women aged ≥70 years with operable breast cancer (n=3375) from 57 UK breast units between 2013 and 2018.

Surgery was performed in 2816 patients (24 excluded for inadequate data). Sixty-two women had bilateral tumours, giving a total of 2854 surgical events. Median age was 76 (range, 70-95) years.

Breast surgery comprised mastectomy in 1138 and breast-conserving surgery in 1716 procedures.

Age, frailty, dementia and co-morbidities were predictors of mastectomy. Age, frailty and co-morbidity were significant predictors of no axillary surgery.

After BCS procedures with positive margins, further operation, as recommended in UK guidelines at the time of the study, was not undertaken in 71.1 per cent of breasts. However, it should be noted that while global and European guidelines accepted 'no tumour at the inked margin', the UK definition is a 'margin >1 mm'.

Contrary to recommended practice, axillary lymph node dissection (ALND) was not carried out after 75.2 per cent of 472 positive sentinel lymph node biopsies, although no distinction was made between macrometastases and micrometastases, which may explain why some patients did not proceed to ALND.

The rate of systemic complications was 2.1 per cent, and there were no surgery-related deaths, showing BCS is safe in the older population.