Management of breast cancer in the elderly by complete local excision and tamoxifen alone.

BACKGROUND: Breast cancer in the elderly is a significant problem, with approximately 30% of all breast cancers occurring in women who are aged 70 or more. Treatments such as axillary dissection, radiotherapy and chemotherapy, part of standard therapy in younger women, have a considerable morbidity and may not be well tolerated in the elderly. The authors report their experience with a more conservative approach to breast cancer in the elderly, using complete local excision combined with long-term tamoxifen (CLE and Tam).
METHODS: Seventy women aged > or = 70 years (median age: 79.5 years; range: 70-93 years) were treated by CLE and Tam, and were followed for a median of 25 months (range: 1-82 months). The study population of 70 women represented a less fit group, with tumours suitable for a breast-conserving approach and without palpable axillary lymph nodes. Follow-up was by clinical examination and annual mammography.
RESULTS: Loco-regional failure occurred in seven women (10%), three of which involved the breast alone, three the axilla alone, and one involved both sites. Five patients had further surgery. Six of the seven patients had high-grade tumours and two of them were oestrogen receptor-negative. Four of the failure group have subsequently died: two with metastatic breast cancer and two from non-malignant disease. Of the whole study group, there have been 12 deaths in the follow-up period: three from metastatic breast cancer and nine from unrelated medical illness.
CONCLUSIONS: It is believed that CLE and Tam provide a simple and safe approach for early non-high-grade breast cancers in elderly women. By such an approach, a large number of elderly women can avoid axillary dissection and radiotherapy.