scholarly journals A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer

2013 ◽  
Vol 95 (5) ◽  
pp. 353-356 ◽  
Author(s):  
S Wylie ◽  
D Ravichandran
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Endocrine Therapy ◽  
Elderly Women ◽  
Breast Surgery ◽  
Significant Proportion ◽  
Operable Breast Cancer ◽  
Breast Cancer Patients ◽  
Primary Endocrine Therapy ◽  
The Uk

Introduction A significant proportion of elderly breast cancer patients in the UK have no surgical treatment recorded and appear to be treated with primary endocrine therapy (PET) only. Despite this, PET remains one of the poorly studied areas in breast cancer therapy and very little is known about the practice of PET in the UK. Methods A questionnaire comprising 14 questions relevant to PET was sent to 489 breast surgeons who were members of the UK Association of Breast Surgery and returned questionnaires were analysed. Results Overall, 228 questionnaires (47%) were returned. The vast majority (93%) of surgeons who responded use PET in early operable breast cancer in elderly women unfit for surgery or owing to patient preference but 7% would recommend PET to fit elderly patients. Most (76%) use letrozole. The percentage of elderly patients treated with PET varied from <10% to 70% between surgeons. The majority (77%) of respondents had not formally audited the outcome of their PET patients and over 70% underestimated the expected survival of an 80-year-old woman. Conclusions Most UK breast surgeons use PET in elderly patients with surgically resectable breast cancer. While most use it in unfit, frail patients, a minority would treat even fit elderly women with PET. Most surgeons have not formally audited the outcome of their patients treated with PET and underestimate the expected survival of elderly patients, which might have an impact on their decision to offer PET rather than surgery.

Anastrozole compared to tamoxifen as primary endocrine therapy for early operable primary breast cancer in the elderly

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11025-11025 ◽  
Author(s):  
M. Ying ◽  
A. Agrawal ◽  
L. Winterbottom ◽  
D. A. Morgan ◽  
I. O. Ellis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Endocrine Therapy ◽  
Aromatase Inhibitors ◽  
Primary Breast Cancer ◽  
The Elderly ◽  
Operable Breast Cancer ◽  
Primary Therapy ◽  
Randomised Study ◽  
Primary Endocrine Therapy

11025 Background: The optimal management of operable primary breast cancer in elderly is controversial. A high proportion of elderly patients refuse or are unfit for surgery. However the majority have oestrogen receptor positive (ER+) cancer and respond extremely well to endocrine therapy. The use of tamoxifen as primary therapy is well established but its efficacy has not been compared with the newer aromatase inhibitors in this setting. We present the clinical data of the use of anastrozole when compared with tamoxifen in elderly patients as primary therapy for operable breast cancer. Methods: During a period of 2 years, elderly patients with ER+ operable breast cancer (<5cm), who either refused or were unfit for surgery, were given primary endocrine therapy. Tamoxifen was given by default but anastrozole was used when there were contraindications (eg thromboembolic and gynaecological risks). All had disease assessable to UICC criteria and were followed up in a dedicated clinic. Only patients who had treatment for =6 months (except for those who progressed prior) were included for analysis. Results: A total of 93 patients fulfilled the criteria for analysis thus far and the results are summarised as follows: 58 were given anastrozole and 35 with tamoxifen. At a median follow-up of 14.8 months (6 to 57), 8 patients have progressed. The results are summarised as follows: CR = complete response PR= partial response SD = stable disease Treatment was well tolerated in both groups and no patients withdrew due to side effects. Conclusions: The use of primary endocrine therapy in ER+ operable breast cancer in the elderly is highly effective. In this observational non randomised study there was no difference in efficacy detected between tamoxifen and anastrozole at this time, as seen in adjuvant trials. This may be due to the fact that majority of ER+ cancer in the elderly are highly ER rich as shown by high semi-quantitative scoring of immunhistological assays, making the superiority of the aromatase inhibitors less apparent. [Table: see text] No significant financial relationships to disclose.

scholarly journals Elderly women with breast cancer often die due to other causes regardless of primary endocrine therapy or primary surgical therapy

The Breast ◽  
2011 ◽  
Vol 20 (4) ◽  
pp. 365-369 ◽  
Author(s):  
M.J. Traa ◽  
C.M.E.M. Meijs ◽  
M.A.C. de Jongh ◽  
E.C.H.M. van der Borst ◽  
J.A. Roukema
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Surgical Therapy ◽  
Elderly Women ◽  
Primary Endocrine Therapy

Surgery versus primary endocrine therapy for elderly women with estrogen receptor-positive early operable primary breast cancer: Survival analysis and correlation with oestrogen receptor positivity

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 612-612
Author(s):  
B. M. Syed ◽  
S. J. Johnston ◽  
D. W. M. Wong ◽  
D. A. L. Morgan ◽  
I. O. Ellis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Primary Breast Cancer ◽  
Oestrogen Receptor ◽  
Elderly Women ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Er Positive ◽  
Primary Endocrine Therapy

612 Background: A recent Cochrane review of seven randomised trials involving 1,446 elderly women (unselected for oestrogen receptor (ER) status) has shown no significant difference in overall survival between surgery (with or without adjuvant tamoxifen) and primary endocrine therapy using tamoxifen. We now report results of a large series from a single centre with a dedicated elderly breast cancer service, with long term follow-up. Methods: During a period of > 20 years, 1,031 elderly (> 70 years) women with ER positive (H-score >50) early operable primary breast cancer received either surgery (with or without adjuvant endocrine therapy) (N = 436) or primary endocrine therapy (N = 595) (>80% using tamoxifen) as initial treatment, with complete follow-up information till deaths. The initial treatment was decided based on fitness for surgery and patient choice. Analysis was carried out on breast cancer specific survival and degree of ER positivity. Results: After a median follow up of 49 months (range 0 - 261 months), patients between 70 - 80 years, treated by surgery, had better 5-year breast cancer specific survival compared to their counterparts treated by primary endocrine therapy (95% versus 85%; p < 0.001). For patients > 80 years, there was however no statistical difference between the two groups (90% versus 90%; p = 0.813). The median survival has not reached yet in all groups. Patients in the latter group (> 80 years) were found to have a higher chance of having strongly ER positive tumours (57% versus 50% in patients between 70 - 80 years with H-score >200; p- < 0.02). Conclusions: In a selected group of elderly women (> 80 years) who tend to have strongly ER positive tumours, surgery and primary endocrine therapy did not appear to produce any difference in breast cancer specific survival. This subject is currently being investigated in a national randomised trial in the UK. No significant financial relationships to disclose.

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