Age-related variation in the treatment and outcomes of patients with breast carcinoma

BACKGROUND. There is controversy regarding the effect of age on breast carcinoma, and previous analyses have often excluded the most elderly patients as well as those with advanced cancers. This study assessed treatment variations and outcome in relation to age for a complete series of patients who presented with breast carcinoma within a defined geographic district. METHODS. Data were collected prospectively for all 784 patients who presented with breast carcinoma in North Bedfordshire, United Kingdom, from 1990 to 1996. Stage of disease, treatment, and outcome were compared for different age groups. RESULTS. Older patients had more advanced cancers: 14% of lymph node negative patients age greater than or equal to 60 years had T3 or T4 tumors compared with 4% of younger lymph node negative patients (P < 0.0001). Treatment varied with age: 94% of lymph node negative patients age greater than or equal to 60 years received tamoxifen compared with 73% of younger lymph node negative patients (P < 0.0001). For lymph node positive patients, outcome was unaffected by age; however, for lymph node negative patients, outcome was best for patients ages 60-69 years: disease free survival was 91% compared with 78% for other ages at 3 years (P = 0.008), and the locoregional recurrence rate was 2% compared with 7% at 3 years (P = 0.04). The improvement in the locoregional recurrence rate applied to all lymph node negative patients age greater than or equal to 60 years: the recurrence rate was 2% compared with 9% for younger patients at 3 years (P = 0.04). CONCLUSIONS. These data support the theory that breast carcinomas are more aggressive in younger patients. The high prescription rate of tamoxifen for older lymph node negative women may have contributed to the low locoregional recurrence rate for this group. (C) 2000 American Cancer Society.