Early breast cancer: omission of adjuvant therapy is worrisome in patients over 70 years

  • Dahn H & al.
  • Breast Cancer Res Treat
  • 21 May 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Local recurrence-free survival (RFS) is worst in patients age >70 years with early breast cancer who do not receive adjuvant therapy.

Why this matters

  • Breast cancer is increasing among patients age >65 years.
  • Omission of adjuvant therapy after breast-conserving surgery in low-risk patients (>70 years) is controversial.
  • These results suggest that some form of adjuvant therapy (radiation alone, endocrine alone, or both) is more advisable.

Study design

  • Retrospective cohort study of 460 patients (age >70 years with early breast cancer) in the Nova Scotia Cancer Registry database.
  • Primary outcome: local RFS.
  • Funding: None.

Key results

  • Vs no adjuvant therapy, local RFS was higher in patients receiving adjuvant therapy:
    • No adjuvant therapy: 88.0% at 5 years and 84.6% at 10 years.
    • Endocrine: 95.8% and 95.8%.
    • Radiation: 98.5% and 94.8%.
    • Both: 99.2% and 99.2%.
    • All P<.05 vs no adjuvant.>
  • On multivariate analysis, RFS (HRs) was lower with no adjuvant vs:
    • Endocrine therapy (±radiation therapy): 3.4 (P=.03). 
    • Radiation therapy (±endocrine therapy): 4.1 (P=.02).
  • Vs no adjuvant therapy, 5-year local-regional RFS was higher (all, P<.05 adjuvant therapy:>
  • No adjuvant therapy: 86.8%.
  • Endocrine alone: 94.4%.
  • Radiation alone: 98.5%.
  • Both: 97.5%.
  • No difference among groups in distant metastasis-free survival.
  • Limitations

    • Retrospective, observational.