COMMENTARY

Surgery or Endocrine Therapy for Early Breast Cancer in Older Women?

Albert B. Lowenfels, MD

Disclosures

December 07, 2018

What is the preferred treatment of older women (> 70 years) with early breast cancer? In a report published in the British Journal of Surgery, the authors used cancer registration data to analyze survival in 10,087 estrogen-positive women treated with surgery, compared with 8643 women treated with endocrine therapy.

The 5-year survival rate was better in the surgery group (89.9%) than in the endocrine therapy group (69.4%). These differences were significant in all age groups (including patients > 90 years), but the differences were not clear-cut in the subgroup of women with the highest comorbidities.

Is Surgery Better? More Studies Are Needed Before Conclusions Can Be Drawn

Although the management of older women with breast cancer has been controversial, many elderly patients are currently treated with endocrine therapy rather than surgery. In this report, based on British registry data, 54% of women were treated with surgery, and 46% had endocrine therapy as the primary treatment. The authors found that surgery provided better survival compared with endocrine therapy, except for the patients with the greatest degree of comorbidity.

The major drawback of this study is that its design, a retrospective analysis of registry data, is not as robust as a randomized trial. In contrast to this study, one of the longest randomized trials comparing the same two forms of treatment had a follow-up period extending to 28 years.[1] That study found no difference in overall breast cancer survival in patients treated with either endocrine therapy (tamoxifen) or surgery.

In recommending treatment, the patient's age and the presence of comorbidities will be the major factors to consider when deciding whether to proceed with surgery or endocrine therapy.

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