The incidence of breast cancer increases with age with approximately 1800 cases per year in the UK occuring in over 90-year olds. We sought to determine the incidence of new breast cancer diagnoses in this subgroup and examine our practice in the management of these women.
A retrospective case-note review was performed on 32 patients aged 90 years and over, diagnosed with non-metastatic invasive breast cancer between 2007 and 2017. Clinicopathological data was collected on patients’ cancers, co-morbidities, treatment, recurrence and survival.
Median age at diagnosis was 90 years (range 90-99). Median number of comorbidities was 2 (range 0-6). Mean tumour size was 35mm (range 5-85). 11 cancers (34%) were ER negative and 2 (6%) HER2 positive. 12 cancers (38%) were grade 3 at presentation and 12 had positive axillary lymph node metastases. Twenty-seven (84%) patients underwent a mastectomy, including one bilateral, and five (16%) patients had wide local excision. No patients suffered significant complications in the immediate post-operative period. Twenty-one patients (66%) had adjuvant radiotherapy. No patients underwent adjuvant chemotherapy. Eight patients (25%) developed local or distant recurrence and twenty-one patients (66%) died by the end of the study collection period. Mean disease free survival was 46.4 months (95% CI 31.1-61.7 months) and mean overall survival was 45 months (95% CI 31.7-59.7 months).
Optimal management for older patients is achieved by the co-evaluation of the life expectancy, co-morbidities, and the treatment benefit/risk ratio. Our data suggests that treating older patients with focused surgical and adjuvant treatment is appropriate, however further age-adjusted data is required to standardise care in this subgroup.
Pennine Acute Hospitals NHS Trust.
Has not received any funding.
All authors have declared no conflicts of interest.