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Cancer. 2018 May 15;124(10):2184-2191. doi: 10.1002/cncr.31308. Epub 2018 Mar 2.

Breast cancer-specific survival by age: Worse outcomes for the oldest patients.

Author information

1
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
2
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
3
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
4
Department of Medical Oncology, INSERM Unit 981, Institute Gustave Roussy, Villejuif, France.
5
Department of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts.
6
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Abstract

BACKGROUND:

Although breast cancer often is perceived to be indolent in older women, breast cancer outcomes in the oldest patients are variable. In the current study, the authors examined breast cancer-specific death by age, stage, and disease subtype in a large, population-based cohort.

METHODS:

Using Surveillance, Epidemiology, and End Results data, a total of 486,118 women diagnosed with American Joint Committee on Cancer stage I to IV breast cancer between 2000 and 2012 were identified. Using a series of Fine and Gray regression models to account for competing risk, the authors examined the risk of breast cancer-specific death by age and stage (I-IV) for subcohorts with hormone receptor (HR)-positive, HR-negative, human epidermal growth factor receptor 2-positive, and triple-negative disease, adjusting for demographic and clinical variables.

RESULTS:

Overall, 18% of women were aged 65 to 74 years, 13% were aged 75 to 84 years, and 4% were aged ≥85 years. Regardless of stage of disease within the HR-positive and HR-negative cohorts, patients aged ≥75 years (vs those aged 55-64 years) experienced a higher adjusted hazard of breast cancer-specific death, which was particularly evident for those with early-stage, HR-positive disease (hazard ratio for those aged 75-84 years, 1.88 [95% confidence interval, 1.68-2.09] and hazard ratio for those aged ≥85 years, 3.59 [95% confidence interval, 3.12-4.13] [both for stage I disease]). In the cohorts with human epidermal growth factor receptor 2-positive and triple-negative disease, women aged ≥70 years had a consistently higher risk of breast cancer-specific death across disease stages (vs those aged 51-60 years), with the exception of stage IV triple-negative disease.

CONCLUSIONS:

Older patients experience worse breast cancer outcomes, regardless of disease subtype and stage. With an increasing number of older patients anticipated to develop breast cancer in the future, addressing disparities for older patients must emerge as a clinical and research priority. Cancer 2018;124:2184-91. © 2018 American Cancer Society.

KEYWORDS:

age; breast cancer; disparities; older women; survival

PMID:
29499074
PMCID:
PMC5935594
[Available on 2019-05-15]
DOI:
10.1002/cncr.31308

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