Surgery improves survival of women over age 80 with breast cancer

Researchers from the Research Unit in Biomedicine and Translational Research in Gynecology and the Gynecological Service of the Vall d’Hebron University Hospital, led by Dr. Antonio Gil, have demonstrated that surgery is the best option to treat women over 80 years with breast cancer in early stages (I and II). The conclusion, published in the European Journal of Surgical Oncology, was obtained after comparing the evolution of 465 women with breast cancer treated in Vall d’Hebron between 1995 and 2012.

Nearly the 30% of women diagnosed with breast cancer are over 80 years old and have, in most of the cases, hormonal tumors. In this situation, oncologists have two options: to operate them in order to remove the tumor, to add radiotherapy or chemotherapy and to give hormone treatment (if it’s necessary); or to administrate a primary endocrine treatment without surgery. One of the principal authors of the study, who is an associate doctor of the Gynecology Service and the Centre of Breast Cancer in Vall d’Hebron, Dr. Tomás Cortadellas, said: “physicians sometimes choose hormone therapy, the less aggressive option, just to avoid the side effects of the surgery standard treatment".

Hormone therapy blocks the hormones and stops the tumor growth, but only for a few years. Specifically, researchers have shown that patients treated with hormone therapy in Vall d’Hebron presented an average of 50 months survival, while the operated women lived 109 months after the diagnosis.

Besides the survival analysis in both groups, researchers observed that, in the operated group, some of them received a less aggressive surgery with suboptimal oncology results. This clinical decision neither help the patients: the ones who received an optimal surgery treatment (removal of the tumor, the sentinel node and other nodes, if it’s necessary) lived, on average, two years and a half more than the ones who received a minor surgery.

At the time of doing the comparative analysis of both groups, Dr. Cortadellas studied patient’s comorbidity (that is to say, the diseases or health problems that patients also presented) to determine if their state of health could influence the treatment they received. To do this, he calculated the Charlson comorbidity index, which evaluates the patient’s life expectancy in the next 10 years. The results were homogeneous: “all the patients included in the study presented the same comorbidity, so we can compare both treatments”, said the physician. A part from this index, in order to confirm the homogeneity of the groups, he also compared other parameters like the chemotherapy and radiotherapy dose they received, the lymphovascular invasion, the tumor stage or the expression of the gene HER2.

The increase in longevity requires changing the treatment

The increase in longevity and the breast cancer prevalence among women over 80 years old raise a new perspective on the management of these patients. Dr Cortadellas, who is preparing the clinical guidelines in this field, recommends that “first is necessary to calculate the life expectancy of each patient because, for example, if it is under three years, hormone therapy is a reasonable choice”. A part of this calculation, the doctor advocates for a geriatric counseling in which the physiological age of the patients is evaluated: their lifestyle, if they live alone, if they manage well with money, if the go to the shops by their own... And all this information will be useful for the doctor to decide what treatment will give the best expectancy and quality of life.

Photo: Dr. Tomás Cortadellas and Dr. Antonio Gil