November 12, 2020

Breast cancer treatment in older women

A new study from Vanderbilt epidemiologists suggests that it’s time to reconsider clinical practice guidelines for the treatment of early-stage breast cancer in older women.

Breast-conserving surgery (BCS) plus radiotherapy is the standard-of-care for women diagnosed with early-stage breast cancer. For women over age 70, however, radiotherapy after BCS is controversial, and U.S. National Comprehensive Cancer Network clinical practice guidelines recommend that it may be omitted. 

To explore the influence of radiotherapy on survival of patients in routine clinical practice, the research team of Xiao-Ou Shu, MD, PhD, MPH, analyzed data in the National Cancer Database from 115,516 women 70 or older treated with BCS for early-stage breast cancer. 

They reported in the International Journal of Cancer that patients who received no radiotherapy had a higher mortality rate than those who received radiotherapy — 5-year survival rate: 71.2% versus 83.8%. Increased mortality was seen for all age groups regardless of the reason for radiotherapy omission and after adjustment for endocrine therapy, chemotherapy and all other known prognostic factors. 

The study suggests that the current recommendation to omit radiotherapy in patients over 70 with early-stage breast cancer may need to be reconsidered.

This research was supported by the Ingram Professorship for Cancer Research to Shu and the China Scholarship Council fund to first author Fei Wang, MD, PhD.