Treatment strategies in elderly breast cancer patients: Is there a need for surgery?

Background: The aim of this study was to determine the role of surgery in elderly patients with breast cancer. Methods: Between 1999 and 2009, 153 consecutive women, >= 80 years old with breast cancer were treated at our hospital. Surgically and non-surgically treated patients were compared with respect to characteristics and survival. Results: Treatment was surgical in 102 patients (67%). The non-surgically treated patients were older than surgically treated patients, had more co-morbidity and were more often diagnosed with a clinically T3/T4 tumour and distant metastasis. Patients not receiving surgery, had an 11% overall survival rate at 5-year versus 48% in surgically treated patients (P <0.001). Independent factors for survival were clinical N0 status, M0 status at presentation and surgery. Conclusion: One in three patients of 80 years and older did not have surgical treatment for breast cancer. Patient not treated surgically are older, have more severe co-morbidity and are diagnosed with more advanced disease than patients who underwent surgery. The selection of patients, who have a poor prognosis, is made on clinical grounds not measurable with a common co-morbidity survey. Better and evidence-based selection criteria for surgical and non-surgical treatment in these patients are needed. (C) 2014 Elsevier Ltd. All rights reserved