J L Morgan1, M W Reed2, L Wyld3. 1. Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: j.morgan@sheffield.ac.uk. 2. Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: m.w.reed@sheffield.ac.uk. 3. Department of Surgical Oncology, E Floor, Medical School, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2JF, UK. Electronic address: l.wyld@sheffield.ac.uk.
Abstract
INTRODUCTION: One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection. METHODS: A systematic review of the literature was performed to try and establish if this form of treatment is still valid in modern breast practice. RESULTS: Six randomised controlled trials (RCTs) and 31 non-randomised studies were deemed eligible. Available data demonstrate an advantage for surgery over PET in terms of disease control and a likely survival benefit in patients with a predicted life expectancy of five years or more. Patients treated only with aromatase inhibitors (AIs) had superior rates of disease control when compared to Tamoxifen. CONCLUSIONS: Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.
INTRODUCTION: One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection. METHODS: A systematic review of the literature was performed to try and establish if this form of treatment is still valid in modern breast practice. RESULTS: Six randomised controlled trials (RCTs) and 31 non-randomised studies were deemed eligible. Available data demonstrate an advantage for surgery over PET in terms of disease control and a likely survival benefit in patients with a predicted life expectancy of five years or more. Patients treated only with aromatase inhibitors (AIs) had superior rates of disease control when compared to Tamoxifen. CONCLUSIONS: Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.
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