Annals of Surgical Oncology

, Volume 22, Issue 8, pp 2492–2499 | Cite as

Deviation from the Standard of Care for Early Breast Cancer in the Elderly: What are the Consequences?

  • Susie X. Sun
  • Christopher S. Hollenbeak
  • Anna M. Leung
Breast Oncology



For elderly patients with early-stage breast cancer, the standards of care often are not strictly followed due to either clinician biases or patient preferences. The authors hypothesized that forgoing radiation and lymph node (LN) staging for elderly patients with early-stage breast cancer would have a negative impact on survival.


From the Surveillance, Epidemiology, and End Results Program database, 53,619 women older than 55 years with stage 1 breast cancer who underwent breast conservation surgery were identified. Analyses were performed to compare the characteristics and outcomes of patients who received the standards of care with LN sampling and radiation and those of patients who did not, with control used for confounders. To account for selection bias from covariate imbalance, propensity score matching was performed. Survival was analyzed using the Kaplan–Meier method.


Older patients were less likely to receive radiation and LN sampling. These standards of care were associated with improved overall survival rates of 15.8 and 27.1 % after 10 years, respectively (p ≤ 0.0001). This survival advantage persisted after propensity score matching, with a 7.4 % higher survival rate for patients who received radiation and a 16.8 % higher survival rate for those who underwent LN staging (p < 0.0001). Lymph node sampling and radiation therapy also conferred a statistically significant improvement in breast cancer-specific survival, with 1.3 and 2.6 % lower mortality rates respectively in the radiated and LN biopsy groups (p < 0.0001).


As patients age, they are less likely to receive the standard of care for stage 1 breast cancer. Even after controlling for other factors, the study showed that failure to adhere to the standards of LN sampling and radiation therapy may have a negative impact in survival.


Sentinel Lymph Node Sentinel Lymph Node Biopsy Lymph Node Biopsy National Comprehensive Cancer Network Early Breast Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.





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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Susie X. Sun
    • 1
  • Christopher S. Hollenbeak
    • 2
  • Anna M. Leung
    • 1
    • 3
  1. 1.Department of Surgery, College of MedicineThe Pennsylvania State UniversityHersheyUSA
  2. 2.Department of Surgery and Public Health Sciences, College of MedicineThe Pennsylvania State UniversityHersheyUSA
  3. 3.Division of Surgical Oncology, Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

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