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Eur J Surg Oncol. 2014 Jun;40(6):676-84. doi: 10.1016/j.ejso.2014.02.224. Epub 2014 Mar 16.

Primary endocrine therapy as a treatment for older women with operable breast cancer - a comparison of randomised controlled trial and cohort study findings.

Author information

1
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: j.morgan@sheffield.ac.uk.
2
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: m.w.reed@sheffield.ac.uk.
3
Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: l.wyld@sheffield.ac.uk.

Abstract

INTRODUCTION:

One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection.

METHODS:

A systematic review of the literature was performed to try and establish if this form of treatment is still valid in modern breast practice.

RESULTS:

Six randomised controlled trials (RCTs) and 31 non-randomised studies were deemed eligible. Available data demonstrate an advantage for surgery over PET in terms of disease control and a likely survival benefit in patients with a predicted life expectancy of five years or more. Patients treated only with aromatase inhibitors (AIs) had superior rates of disease control when compared to Tamoxifen.

CONCLUSIONS:

Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.

KEYWORDS:

Breast cancer; Elderly; Primary endocrine therapy; Surgery; Systematic review

PMID:
24703110
DOI:
10.1016/j.ejso.2014.02.224
[Indexed for MEDLINE]

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