A new study published in the British Journal of Surgery warns against omitting surgery in the management of older women with oestrogen receptor (ER)-positive breast cancer (BCa).
Previous studies have shown that up to 40 per cent of UK women over 70 years of age with early BCa are treated with primary endocrine therapy rather than surgery. This latest research analysed 2002-2010 cancer registration data on 23,961 women from two English regions to investigate the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women.
Of the 23,849 women, 78.5 per cent (n=18,730) were identified as having ER-positive BCa. Of these, 10,087 (53⋅9%) underwent surgery and 8,643 (46⋅1%) received primary endocrine therapy.
BCSS was found to be significantly poorer in the primary endocrine therapy group versus the surgical group. Five-year BCSS rates were 69⋅4 per cent and 89⋅9 per cent. The difference was greatest in patients who would have otherwise had a high life expectancy. For older, frailer patients, the effect of non-surgical treatment on survival outcomes would be less. The authors say that in some patients, this difference may be so small that primary endocrine therapy would be the preferred treatment option to avoid any potential morbidity associated with surgery.
However, they also say that “higher rates of primary endocrine therapy in the UK than in many other developed countries could explain, at least in part, the inferior relative survival for breast cancer in this age group in the UK compared with that in a number of other developed nations”.
