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.
Clinical trial identification
Legal entity responsible for the study
Pennine Acute Hospitals NHS Trust.
Has not received any funding.
All authors have declared no conflicts of interest.