Management of early breast cancer in older women: from screening to treatment

Figures & data

Table 1 The incidence and the mortality of breast cancer in France

Age (years)	Incidence/100,000	Mortality/100,000
60–64	299.8	61.3
65–69	386.1	73.4
70–74	341.8	84.6
75–79	295.8	101.2
80–84	304.4	132.6
85–89	338	183
90–94	283.6	273.9
>95	255.3	309.9

Table 2 Summary of different studies comparing surgery ± hormonal therapy in older women

Name of study	Number of patients included	Study design	Median duration of survival (years)	Progression-free survival	Overall survival
EORTC 10851 (UK) (Fentiman et al^Citation14)	164	Surgery vs tamoxifen 20 mg/d	10	63/82 vs 69/82# HR: 0.55	60/82 vs 50/82# HR: 1.11 (0.75–1.65)$
Nottingham (UK) (Robertson et al^Citation12)	131	Surgery vs tamoxifen 40 mg/d	5	56/65 vs 57/66# HR: not estimated	28/65 vs 28/66# HR: 1.06 (0.59–1.92)$
St Georges (UK) (Gazet et al^Citation13)	200	Surgery vs tamoxifen 20 mg/j	6	60/100 vs 70/100# HR: not estimated	28/100 vs 33/100# HR: 0.75 (0.44–1.26)$
CRC (UK) (Fennessey et al^Citation20)	455	Surgery plus tamoxifen 40 mg/j vs tamoxifen only	13	Not reported	159/225 vs 187/230# HR: 0.78 (0.63–0.96)$
GRETA (Italy) (Mustacchi et al^Citation15)	274	Surgery plus radiotherapy plus tamoxifen 20 mg/d vs tamoxifen only	7	140/239 vs 188/235# HR: 0.65 (0.53–0.81)$	130/239 vs 144/235# HR: 0.98 (0.77–1.25)$
Naples (Italy) (Capasso et al^Citation21)	75	Surgery plus radiotherapy plus tamoxifen 20 mg/d vs tamoxifen only 160 mg/d then 20 mg/d until progression	10	9/38 vs 13/37# P=0.4594	121 months vs 123 months P=0.8
Nottingham.2 (UK) (Willsher et al^Citation19)	147	Surgery plus tamoxifen vs tamoxifen 20 mg/j	5	Not reported	8/53 vs 14/94# HR: 0.80 (0.73–2.32)$

Notes:

# Number of patients who have progressed by the total number of patients included in each arms of the study;

$ data are expressed in months, and values in parentheses indicate the confidence interval of hazard ratio.

Abbreviation: HR, hazard ratio; d, day.

Table 3 Summary of different studies comparing adjuvant hormonal therapy with tamoxifen vs placebo in older women

Name of study	Study design	Median duration of follow-up	Progression-free survival	Overall survival
Castiglone et al^Citation38	the study included 320 patients aged between 66 and 80 years. They received Tamoxifen 20mg/day and prednisone	96 months	36% vs 22% P=0.004	49% vs 42% P=0.43
Crivellari et al^Citation41	349 patients included aged between 66 and 80 years. Mastectomy followed by tamoxifen and prednisone vs no treatment	21 years	Improvement of progression free survival (P=0.003)	Improvement of 15 years overall survival and relapse-free survival, 10%±3% vs 19%±3% HR, 0.71;$ 95% CI, 0.58 to 0.86$
Mouridsen et al^Citation40	509 patients included were 70 years old or more tamoxifen and local irradiation vs irradiation only	6 years	48% vs 39% P=0.0008	No difference in overall survival
Cummings et al^Citation39	181 patients included were 65–84 years old tamoxifen over 2 years vs placebo	10 years	7.4 vs 4.4 years P=0.001	8.5 vs 8 years P=0.063

Note:

$ Data are expressed in months.

Abbreviations: CI, confidence interval; HR, hazard ratio.

FentimanISChristiaensMRParidaensREORTC treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomyEur J Cancer20033930931612565982

 PubMed Web of Science ®Google Scholar

RobertsonJFToddJHEllisIOElstonCWBlameyRWComparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancerBMJ19882975115143139179

 PubMedGoogle Scholar

GazetJCFordHTCoombesRCProspective randomized trial of tamoxifen vs surgery in elderly patients with breast cancerEur J Surg Oncol1994202072148181594

 PubMedGoogle Scholar

FennesseyMBatesTMcRaeKRileyDHoughtonJBaumMRandomised trial of surgery plus tamoxifen vs tamoxifen-alone in women over age 70 with operable breast cancerBr J Surg20049169970415164437

 PubMed Web of Science ®Google Scholar

MustacchiGCeccheriniRMilaniSItalian Cooperative Group GRETATamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trialAnn Oncol20031441442012598347

 PubMed Web of Science ®Google Scholar

CapassoINuzzoFLaboniaVLandiGRossiEDe MatteisASurgery and tamoxifen vs tamoxifen as treatment of stage I and II breast cancer in over to 70 years old women: ten years follow-upAnn Oncol20001120

 Web of Science ®Google Scholar

WillsherPCRobertsonJFRJacksonLAl-HilalyMBlarneyRWInvestigation of primary tamoxifen therapy for elderly patients with operable breast cancerBreast19976150154

 Web of Science ®Google Scholar

CastiglioneMGelberRDGoldhirshAAdjuvant systemic therapy for breast cancer in the elderly: competing causes of mortalityJ Clin Oncol1990835195262407812

 PubMed Web of Science ®Google Scholar

CrivellariDPriceKRichardDAdjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer: 21-year results of International Breast Cancer Study Group Trial IVJ Clin Oncol2003214517452314673038

 PubMed Web of Science ®Google Scholar

MouridsenHTAndersenAPBrinckerHAdjuvant tamoxifen in post-memopausal high risk breast cancer patients: present status of Danish breast cancer cooperative group trialsNCI Monogr198511151183534583

 PubMedGoogle Scholar

CummingsFJGrayDCTormeyTEAdjuvant tamoxifen versus placebo in elderly women with node-positive breast cancer: long-term follow-up and causes of deathJ Clin Oncol199311129358418238

 PubMed Web of Science ®Google Scholar