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Management of Breast Cancer in Older Women pp 97–116Cite as

The Surgical Management of Breast Cancer in Elderly Women

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Abstract

One third of all women diagnosed with breast cancer are over 70 years of age, equating to some 13,000 women in the UK annually. As the UK population ages, this number will increase. Whilst many of these older women will be fit for standard therapies, increasing age, frailty, and co-morbidity levels may render some women unfit for certain treatments. This chapter will deal with the role of surgery in these women. It has long been recognized that older women do not receive the same surgical and adjuvant treatments as younger women and the evidence base for treating older women with breast cancer is weak due to the historic exclusion of these women from research studies. This Chapter summarises the current evidence for the surgical management of older womed with breat cancer and suggests strategies to deliver treatment based on available evidence and in conjunction with patients and those close to them.

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References

  1. Alderman AK, McMahon L Jr, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg. 2003;111:695–703; discussion 704–705.

    Article  PubMed  Google Scholar 

  2. Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36:1938e43.

    Article  Google Scholar 

  3. Athanasiou I, Reed M, Shrestha A, Cheung KL, Audisio R, Collins K, Wyld L. Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: analysis of the age gap trial. 2018. https://doi.org/10.1016/j.ejso.2018.02.034.

    Article  Google Scholar 

  4. Audisio RA, Veronesi P, Ferrario L, Cipolla C, Andreoni B, Aapro MS. Elective surgery in gastrointestinal tumors in the aged. Ann Oncol. 1997;8(4):317–27.

    Article  CAS  PubMed  Google Scholar 

  5. Audisio RA, Osman N, Audisio MM, et al. How do we manage breast cancer in the elderly patients? A survey among members of the British Association of Surgical Oncologists (BASO). Crit Rev Oncol Hematol. 2004;52:135–41.

    PubMed  Google Scholar 

  6. Audisio RA, Ramesh H, Longo WE, et al. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.

    Article  PubMed  Google Scholar 

  7. Balasubramanian SP, Murrow S, Holt S, et al. Audit of compliance to adjuvant chemotherapy and radiotherapy guidelines in breast cancer in a cancer network. Breast. 2003;12:136–41.

    Article  CAS  PubMed  Google Scholar 

  8. Bates T, Evans T, Lagord C, Monypenny I, Kearins O, Lawrence G. A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women. Eur J Surg Oncol. 2014;40(10):1230–6.

    Article  CAS  PubMed  Google Scholar 

  9. BCCOM. Breast cancer clinical outcome measures report. 2007. http://www.wmpho.org.uk/wmciu/documents/BCCOM%20Year%20.3%20report.pdf.

  10. Biganzoli L, Wildiers H, Oakman C, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012;13(4):148–60.

    Article  Google Scholar 

  11. Bouchardy C, Rapiti E, Fioretta G, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.

    Article  PubMed  Google Scholar 

  12. Boughey JC, Haffty BG, Habermann EB, Hoskin TL, Goetz MP. Has the time come to stop surgical staging of the axilla for all women age 70 years or older with hormone receptor-positive breast cancer? Ann Surg Oncol. 2017;24(3):614–7.

    Article  PubMed  Google Scholar 

  13. Breast Cancer Clinical Outcome Measures (BCCOM) report. 2007. http://www.wmpho.org.uk/wmciu/documents/BCCOM%20Year%203%20report.pdf.

  14. Burton M, Collins KA, Lifford KJ, Brain K, Wyld L, Caldon L, Gath J, Revell D, Reed MW. The information and decision support needs of older women (≥75 years) facing treatment choices for breast cancer: a qualitative study. Psychooncology. 2015;24:878–84. https://doi.org/10.1002/pon.3735.

    Article  PubMed  Google Scholar 

  15. Capasso INF, Labonia V, et al. Survery + tamoxifen vs tamoxifen as treatment of stage I and II breast cancer in over to 70 years old women; ten years follow-up. Ann Oncol. 2000;11(4):20.

    Google Scholar 

  16. Chagpar AB, McMasters KM, Edwards MJ, North American Fareston Tamoxifen Adjuvant Trial. Can sentinel node biopsy be avoided in some elderly breast cancer patients? Ann Surg. 2009;249(3):455–60. https://doi.org/10.1097/SLA.0b013e318194d16b.

    Article  PubMed  Google Scholar 

  17. Chagpar AB, Horowitz N, Sanft T, Wilson LD, Silber A, Killelea B, Moran MS, DiGiovanna MP, Hofstatter E, Chung G, Pusztai L, Lannin DR. Does lymph node status influence adjuvant therapy decision-making in women 70 years of age or older with clinically node negative hormone receptor positive breast cancer? Am J Surg. 2017;214(6):1082–8.

    Article  PubMed  Google Scholar 

  18. Chakrabarti J, Kenny F, Syed B, Robertson J, Blamey R, Cheung K. A randomised trial of mastectomy only versus tamoxifen for treating elderly patients with operable primary breast cancer-final results at 20-year follow-up. Crit Rev Oncol Hematol. 2011;78(3):260–4.

    Article  CAS  PubMed  Google Scholar 

  19. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  20. Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375–91. https://doi.org/10.1245/s10434-009-0792-y.

    Article  PubMed  Google Scholar 

  21. Cole MG, Primeau F, McCusker J. Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review. CMAJ. 1996;155:1263–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Collins K, Winslow M, Reed MW, Walters SJ, Robinson T, Madan J, Green T, Cocker H, Wyld L. The views of older women towards mammographic screening: a qualitative and quantitative study. Br J Cancer. 2010;102(10):1461–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Collins K, Burton M, Reed M, Lifford K, et al. Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial. BMJ Open. 2017;7(7):e015133. https://doi.org/10.1136/bmjopen-2016-015133.

    Article  PubMed  PubMed Central  Google Scholar 

  24. De Boniface J, Frisell J, Bergkvist L, Andersson Y. Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation. Br J Surg. 2018. https://doi.org/10.1002/bjs.10889. [Epub ahead of print].

    Article  CAS  Google Scholar 

  25. De Glas NA, Bastiaannet E, Engels CC, de Craen AJ, Putter H, van de Velde CJ, Hurria A, Liefers GJ, Portielje JE. Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer. 2016;114(4):395–400.

    Article  PubMed  PubMed Central  Google Scholar 

  26. De Kruijf EM, Bastiaannet E, Ruberta F, de Craen AJ, Kuppen PJ, Smit VT, van de Velde CJ, Liefers GJ. Comparison of frequencies and prognostic effect of molecular subtypes between young and elderly breast cancer patients. Mol Oncol. 2014;8(5):1014–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Derks MGM, Liefers GJ, Kiderlen M, Hilling DE, Boelens PGM, Walsh PM, Van Eycken E, Siesling S, Broggio J, Wyld L, Trojanowski M, Chalubinska-Fendler J, Nowikiewicz T, Gonçalves AF, Audisio RA, Van de Velde CJH, Bastiaannet E, on behalf of the EURECCA Breast Cancer Group. Variation in treatment and survival in older women with non-metastatic breast cancer in Europe:A population based study from the EURECCA Breast Cancer Group. Eur J Cancer. 2018, in press.

    Google Scholar 

  28. Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000;92:550–6.

    Article  CAS  PubMed  Google Scholar 

  29. Dominici LS, Sineshaw HM, Jemal A, Lin CC, King TA, Freedman RA. Patterns of axillary evaluation in older patients with breast cancer and associations with adjuvant therapy receipt. Breast Cancer Res Treat. 2018;167(2):555–66.

    Article  PubMed  Google Scholar 

  30. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Eaker S, Dickman PW, Bergkvist L, et al. Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden. PLoS Med. 2006;3:e25.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ellis MJ, Ma C. Letrozole in the neoadjuvant setting: the P024 trial. Breast Cancer Res Treat. 2007;105:33–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. EUSOMA DB Working Group, Tomatis M, Heil J, Friedrichs K, Kreienberg R, Denk A, Kiechle M, et al. Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer. 2012;13(48):1947–56.

    Google Scholar 

  34. Extermann M, Meyer J, McGinnis M, et al. A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Crit Rev Oncol Hematol. 2004;49:69–75.

    Article  PubMed  Google Scholar 

  35. Fallowfield LJ, Hall A, Maguire P, et al. Psychological effects of being offered choice of surgery for breast cancer. BMJ. 1994;309:448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Fennessy M, Bates T, MacRae K, et al. Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer. Br J Surg. 2004;91:699–704.

    Article  CAS  PubMed  Google Scholar 

  37. Fentiman IS, van Zijl J, Karydas I, et al. Treatment of operable breast cancer in the elderly: a randomized clinical trial EORTC 10850 comparing modified radical mastectomy with tumorectomy plus tamoxifen. Eur J Cancer. 2003;39:300–8.

    Article  CAS  PubMed  Google Scholar 

  38. Figueiredo MI, Cullen J, Hwang Y-T, Rowland JH, Mandelblatt JS. Breast cancer treatment in older women: does getting what you want improve your long term body image and mental health? J Clin Oncol. 2004;22(19):4002–9.

    Article  PubMed  Google Scholar 

  39. Fleissig A, Fallowfield LJ, Langridge CI, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.

    Article  PubMed  Google Scholar 

  40. Fobair P, Stewart SL, Chang S, et al. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15:579e94.

    Article  Google Scholar 

  41. Fornage BD, Hwang RF. Current status of imaging-guided percutaneous ablation of breast cancer. Am J Roentgenol. 2014;203(2):442. https://doi.org/10.2214/AJR.13.11600.

    Article  Google Scholar 

  42. Franzoi SL, Koehler V. Age and gender differences in body attitudes: a comparison of young and elderly adults. Int J Aging Hum Dev. 1998;47:1–10.

    Article  CAS  PubMed  Google Scholar 

  43. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

  44. Gazet JC, Ford HT, Coombes RC, et al. Prospective randomized trial of tamoxifen vs surgery in elderly patients with breast cancer. Eur J Surg Oncol. 1994;20:207–14.

    CAS  PubMed  Google Scholar 

  45. Gentilini O, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009;113:577–83.

    Article  PubMed  Google Scholar 

  46. Gianni L, Pienkowski T, Im YH, Roman L, Tseng LM, Liu MC, Lluch A, Staroslawska E, de la Haba-Rodriguez J, Im SA, Pedrini JL, Poirier B, Morandi P, Semiglazov V, Srimuninnimit V, Bianchi G, Szado T, Ratnayake J, Ross G, Valagussa P. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25–32. https://doi.org/10.1016/S1470-2045(11)70336-9. Epub 2011 Dec 6.

    Article  CAS  PubMed  Google Scholar 

  47. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75. https://doi.org/10.1001/jama.2011.90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264:413–20.

    Article  PubMed  Google Scholar 

  49. Goldberg JA, Scott RN, Davidson PM, et al. Psychological morbidity in the first year after breast surgery. Eur J Surg Oncol. 1992;18:327e31.

    Google Scholar 

  50. Gosney MA. Clinical assessment of elderly people with cancer. Lancet Oncol. 2005;6:790–7.

    Article  PubMed  Google Scholar 

  51. Guth U, Myrick ME, Viehl CT, Weber WP, Lardi AM, Schmid SM. Increasing rates of contralateral prophylactic mastectomy–A trend made in USA? 52. Eur J Surg Oncol. 2012;38(4):296–301.

    Google Scholar 

  52. Hamazoe R, Maeta M, Murakami A, et al. Heating efficiency of radiofrequency capacitive hyperthermia for treatment of deep–seated tumors in the peritoneal cavity. J Surg Oncol. 1991;48:176–9.

    Article  CAS  PubMed  Google Scholar 

  53. Hind D, Wyld L, Reed MW. Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: cochrane review. Br J Cancer. 2007;96:1025–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Hofvind S, Holen Å, Aas T, Roman M, Sebuødegård S, Akslen LA. Women treated with breast conserving surgery do better than those with mastectomy independent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol. 2015;41:1417–22.

    Article  CAS  PubMed  Google Scholar 

  55. Houterman S, Janssen-Heijnen ML, Verheij CD, et al. Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Br J Cancer. 2004;90:2332–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: Long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hunt KE, Fry DE, Bland KI. Breast carcinoma in the elderly patient: an assessment of operative risk, morbidity and mortality. Am J Surg. 1980;140:339–42.

    Article  CAS  PubMed  Google Scholar 

  58. Husain LS, Collins K, Reed M, et al. Choices in cancer treatment: a qualitative study of the older women’s (>70 years) perspective. Psychooncology. 2008;17:410–6.

    Article  PubMed  Google Scholar 

  59. Inouye SK, Peduzzi PN, Robison JT, et al. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA. 1998;279:1187–93.

    Article  CAS  PubMed  Google Scholar 

  60. Jeffrey SS, Birdwell RL, Ikeda DM, et al. Radiofrequency ablation of breast cancer: first report of an emerging technology. Arch Surg. 1999;134:1064–8.

    Article  CAS  PubMed  Google Scholar 

  61. Kesseler HJ, Seton JZ. The treatment of operable breast cancer in the elderly female. Am J Surg. 1978;135:664–6.

    Article  CAS  PubMed  Google Scholar 

  62. Kiderlen M, Bastiaannet E, Walsh PM, et al. Surgical treatment of early stage breast cancer in elderly: an international comparison. Breast Cancer Res Treat. 2012;132:675–82.

    Article  CAS  PubMed  Google Scholar 

  63. King MT, Kenny P, Shiell A, Hall J, Boyages J. Quality of life 3 months and 1 year after first treatment for early stage breast cancer: Influence of treatment and patient characteristics. Qual Life Res. 2000;9:789–800.

    Article  CAS  PubMed  Google Scholar 

  64. Kissin MW, Della Rovere GQ, Easton D, et al. Risk of lymphedema following the treatment of breast cancer. Br J Surg. 1986;73:580–4.

    Article  CAS  PubMed  Google Scholar 

  65. Kitowski NJ, Landercasper J, Gundrum JD, De Maiffe BM, Chestnut DH, Bottcher ML, et al. Local and paravertebral block anesthesia for outpatient elective breast cancer surgery. Arch Surg. 2010;145:592–4.

    Article  PubMed  Google Scholar 

  66. Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003;30:799e813.

    Article  Google Scholar 

  67. Kunkler IH, Williams LJ, Jack WJL, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II). Lancet Oncol. 2015;16:266–73.

    Article  PubMed  Google Scholar 

  68. Lavelle K, Todd C, Moran A, et al. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or >65 years. Br J Cancer. 2007;96:1197–203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Lipa JE, Youssef AA, Kuerer HM, et al. Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg. 2003;111:1110–21.

    Article  PubMed  Google Scholar 

  70. Louwman WJ, Janssen-Heijnen ML, Houterman S, et al. Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer. 2005;41:779–85.

    Article  CAS  PubMed  Google Scholar 

  71. Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98:599–609.

    Article  PubMed  Google Scholar 

  72. Martelli G, Miceli R, Daidone MG, Vetrella G, Cerrotta AM, Piromalli D, et al. Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol. 2011;18:125–33.

    Article  PubMed  Google Scholar 

  73. Mauri G, Sconfienza LM, Pescatori LC, Fedeli MP, Alì M, Di Leo G, Sardanelli F. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: a systematic review and meta-analysis. Eur Radiol. 2017;27(8):3199–210.

    Article  PubMed  Google Scholar 

  74. Morgan J, Richards P, Ward S, Francis M, Lawrence G, Collins K, Reed M, Wyld L. Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer. Br J Surg. 2015;102(9):1056–63.

    Article  CAS  PubMed  Google Scholar 

  75. Mustacchi G, Ceccherini R, Milani S, et al. Tamoxifen alone versus adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial. Ann Oncol. 2003;14:414–20.

    Article  CAS  PubMed  Google Scholar 

  76. National Audit of Breast Cancer in Older Patients (NABCOP) 2017 annual report. https://www.nabcop.org.uk/reports/nabcop-2017-annual-report/.

  77. National Audit of Breast Cancer in Older Patients (NABCOP) 2018 annual report. https://www.nabcop.org.uk/reports/nabcop-2018-annual-report/.

  78. National Mastectomy and Breast Reconstruction Audit 2011. Leeds, National Health Service Information Centre. 2011.

    Google Scholar 

  79. NICE. Early and locally advanced breast Cancer: full guideline. National Collaborating Centre for Cancer: Cardiff; 2009.

    Google Scholar 

  80. Oakley N, Dennison AR, Shorthouse AJ. A prospective audit of simple mastectomy under local anesthesia. Eur J Surg Oncol. 1996;22:134–6.

    Article  CAS  PubMed  Google Scholar 

  81. PACE Participants. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help – a SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65(2):156–63.

    Article  Google Scholar 

  82. Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Sunouchi K, Stotter A, West C, Audisio RA. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15(4):189–97.

    Article  CAS  PubMed  Google Scholar 

  83. Preece PE, Wood RA, Mackie CR, et al. Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J (Clin Res Ed). 1982;284:869–70.

    Article  CAS  Google Scholar 

  84. Ramesh HSJ, Pope D, Gennari R, Audisio RA. Optimising surgical management of elderly cancer patients. World J Surg Oncol. 2005;3:17.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Ray C. Psychological implications of mastectomy. Br J Soc Clin Psychol. 1977;16:373e7.

    Article  Google Scholar 

  86. Reaby LL. Reasons why women who have mastectomy decide to have or not to have breast reconstruction. Plast Reconstr Surg. 1998;101:1810–8.

    Article  CAS  PubMed  Google Scholar 

  87. Read WL, Tierney RM, Page NC, Costas I, Govindan R, Spitznagel EL, Piccirillo JF. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22(15):3099–103.

    Article  PubMed  Google Scholar 

  88. Repetto L, Audisio RA. Elderly patients have become the leading drug consumers: it’s high time to properly evaluate new drugs within the real targeted population. J Clin Oncol. 2006;24(35):e62–3.

    Article  PubMed  Google Scholar 

  89. Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20:494–502.

    Article  PubMed  Google Scholar 

  90. Robertson JF, Ellis IO, Elston CW, Blamey RW. Mastectomy or tamoxifen as initial therapy for operable breast cancer in elderly patients: 5-year follow-up. Eur J Cancer. 1992;28A(4–5):908–10.

    Article  CAS  PubMed  Google Scholar 

  91. Rudenstam CM, Zahrieh D, Forbes JF, et al. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol. 2006;24:337–44.

    Article  PubMed  Google Scholar 

  92. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–10.

    Article  CAS  PubMed  Google Scholar 

  93. Sávolt Á, Péley G, Polgár C, Udvarhelyi N, Rubovszky G, Kovács E, et al. Eight-year follow up result of the OTOASOR trial: the optimal treatment of the axilla – surgery or radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: a randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017;43(4):672–9.

    Article  PubMed  Google Scholar 

  94. Singletary SE, Dowlatshahi K, Dooley WC, et al. Minimally invasive operation for breast cancer. Curr Probl Surg. 2004;41:385–447.

    Article  PubMed  Google Scholar 

  95. Suemoto et al. (2016) https://eprognosis.ucsf.edu/suemoto.php. Accessed 27 Feb 2019.

  96. Syed BM, Green AR, Paish EC, Soria D, Garibaldi J, Morgan L, Morgan DA, Ellis IO, Cheung KL. Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts. Br J Cancer. 2013;108(5):1042–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Truong PT, Bernstein V, Wai E, et al. Age-related variations in the use of axillary dissection: a survival analysis of 8038 women with T1-ST2 breast cancer. Int J Radiat Oncol Biol Phys. 2002;54:794–803.

    Article  PubMed  Google Scholar 

  98. Van Maaren MC, de Munck L, de Bock GH, Jobsen JJ, van Dalen T, Linn SC, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol. 2016;17:1158–70.

    Article  PubMed  Google Scholar 

  99. Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.

    Article  PubMed  Google Scholar 

  100. Vlastos G, Verkooijen HM. Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer. Oncologist. 2007;12(1):1–10.

    Article  PubMed  Google Scholar 

  101. Ward SE, Richards P, Morgan J, Holmes GR, Broggio J, Collins K, Reed MW, Wyld L. Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer specific survival. Br J Surg. 2018;105:1454–63.

    Article  CAS  PubMed  Google Scholar 

  102. Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of delirium following elective surgery: a systematic review and meta-analysis. J Gen Intern Med. 2018;33(4):500–9. https://doi.org/10.1007/s11606-017-4204-x.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Wildiers H, Kunkler I, Biganzoli L, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8:1101–15.

    Article  PubMed  Google Scholar 

  104. Willsher PC, Robertson JF, Jackson L, Al-Hilaly M, Blamey RW. Investigation of primary tamoxifen therapy for elderly patients with operable breast cancer. Breast. 1997;6:150–4.

    Article  Google Scholar 

  105. Wyld L, Garg DK, Kumar ID, et al. Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines. Br J Cancer. 2004;90:1486–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Wylie S, Ravichandran D. A United Kingdom national survey of breast surgeons on primary endocrine therapy of early operable breast cancer. Eur J Surg Oncol. 2012;38(5):423.

    Article  Google Scholar 

  107. Zumsteg ZS, Morrow M, Arnold B, Zheng J, Zhang Z, Robson M, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1–2 N0 triple-negative breast cancer. Ann Surg Oncol. 2013;20:3469–76.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. The Park Centre for Breast Care, Brighton and Sussex University Hospital, Brighton, UK

    Fiammetta Ugolini

  2. Brighton and Sussex Medical School, Brighton, UK

    Malcolm Reed

  3. Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK

    Lynda Wyld

  4. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK

    Lynda Wyld

  5. Department of Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden

    Riccardo A. Audisio

Authors
  1. Fiammetta Ugolini
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  2. Malcolm Reed
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  3. Lynda Wyld
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  4. Riccardo A. Audisio
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Corresponding author

Correspondence to Riccardo A. Audisio .

Editor information

Editors and Affiliations

  1. Brighton and Sussex Medical School, Brighton, UK

    Malcolm Reed

  2. Department of Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden

    Riccardo A. Audisio

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Ugolini, F., Reed, M., Wyld, L., Audisio, R.A. (2019). The Surgical Management of Breast Cancer in Elderly Women. In: Reed, M., Audisio, R. (eds) Management of Breast Cancer in Older Women. Springer, Cham. https://doi.org/10.1007/978-3-030-11875-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-11875-4_7

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