Importance of adequate staging and of hormone receptors in women older than age 70 with breast cancer.

This report includes 479 women older than 70 years of age who were operated on between January 1980 and January 1988 and who were followed for 2.5 to 10.5 years (mean, 4.6 years). There were no operative deaths. Staging was available on 90.8%. Eighty-one per cent of patients were estrogen receptor positive (ER+), and 64% had negative lymph nodes (LN-). There were 50 deaths from breast cancer (10.4%), and 56 (11.6%) from other causes (mostly cardiovascular). Estrogen receptor negativity was significant by both univariate and multivariate analysis for increased risk of death from breast cancer (by factors of 3 and 1.4). Only four of 152 (2.6%) women who were node negative and estrogen receptor positive died during the follow-up of 4.9 years. The results of this study suggest that elderly women should be fully staged with axillary node dissections, and the hormone receptor assay should be performed because these are important indicators of prognosis. Because only 2.6% of the LN- and ER+ women in this study died of breast cancer, and only 3% in this group were treated with adjuvant systemic therapy (tamoxifen), the authors conclude that this therapy is unnecessary, although a prospective randomized study of elderly women would be required to state this definitively.