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Population-based analysis of non-operative management and treatment patterns in older women with estrogen receptor-positive breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To examine the proportion of older women with ER + HER2- breast cancer receiving non-operative management versus surgery, and to evaluate the use of axillary staging and adjuvant radiation in this population.

Methods

We queried the SEER database to identify all women aged 70 years or older with stage I–III ER + HER2- invasive breast cancer diagnosed between 2010 and 2016. We evaluated trends in non-operative management, breast surgery, axillary staging, and adjuvant radiation according to age at diagnosis.

Results

We identified 57,351 older women with ER + HER2- disease. Overall, 3538 (6.2%) of the cohort underwent non-operative management, 38,452 (67.0%) underwent breast-conserving surgery (BCS), and 15,361 (26.8%) underwent mastectomy. The proportion of patients undergoing non-operative management increased from 2.8% among 70–74-year-old women to 30.1% in those ≥ 90 years old (p < 0.001). In 53,813 women who underwent surgery, 36,850 (68.5%) underwent sentinel lymph node biopsy, while 10,861 (20.2%) underwent axillary lymph node dissection. Subgroup analysis of 29,032 older women undergoing BCS for stage I ER + HER2- breast cancer revealed a 14.2% rate of omission of axillary staging, increasing from 5.3% in those 70–74 years to 67.6% in those ≥ 90 years old (p < 0.001). Receipt of adjuvant radiation occurred in 63.3% of older women following BCS and 18% post-mastectomy, with similar trends towards omission in older age groups.

Conclusion

Primary breast surgery remains the dominant management strategy for the majority of older women with ER + HER2- breast cancer. Omission of axillary staging and adjuvant radiation are used in a minority of eligible women undergoing breast conservation for early-stage disease.

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Data availability

Data are publicly available from the National Cancer Institute’s SEER database.

Code availability

Available upon request.

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Funding

Stephanie M Wong was supported by the FRQS Clinical Research Scholar award.

Author information

Authors and Affiliations

  1. Department of Surgery, McGill University Medical School, Montreal, QC, Canada

    David Tejera, Mariam Rana, Mark Basik, Jean Francois Boileau, Richard Margolese, Ipshita Prakash, Ari N. Meguerditchian & Stephanie M. Wong

  2. Segal Cancer Centre, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, Montreal, QC, H3T1E2, Canada

    Mark Basik & Stephanie M. Wong

  3. Department of Oncology, McGill University Medical School, Montreal, QC, Canada

    Mark Basik, Richard Margolese, Ipshita Prakash, Ari N. Meguerditchian, Thierry Muanza & Stephanie M. Wong

  4. St-Mary’s Research Centre, West Island University Health and Social Services Centre, Montreal, QC, Canada

    Ari N. Meguerditchian

  5. McGill University Health Centre Research Institute, Montreal, QC, Canada

    Ari N. Meguerditchian

  6. Department of Radiation Oncology, McGill University Medical School, Montreal, QC, Canada

    Thierry Muanza

  7. Department of Geriatric Oncology, McGill University Medical School, Montreal, QC, Canada

    Johanne Monette

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  1. David Tejera
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DT and SMW. The first draft of the manuscript was written by DT and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephanie M. Wong.

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The authors have no conflicts of interest to declare.

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Waived by the Institutional Review Board of the Jewish General Hospital due to the use of anonymized, publicly available de-identified data.

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Tejera, D., Rana, M., Basik, M. et al. Population-based analysis of non-operative management and treatment patterns in older women with estrogen receptor-positive breast cancer. Breast Cancer Res Treat 190, 491–501 (2021). https://doi.org/10.1007/s10549-021-06393-3

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