S E Ward1, P D Richards1, J L Morgan2, G R Holmes1, J W Broggio3,4, K Collins5, M W R Reed6, L Wyld2. 1. Department of Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. 2. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK. 3. National Cancer Registration and Analysis Service, Public Heath England, Birmingham, UK. 4. Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 5. Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK. 6. Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton UK.
Abstract
BACKGROUND: Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women. METHODS: Cancer registration data for 2002-2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health status on BCSS. Missing data were handled using multiple imputation. RESULTS: Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of 23 849 women (78·5 per cent) were identified as having ER-positive disease; of these, 10 087 (53·9 per cent) had surgery and 8643 (46·1 per cent) had primary endocrine therapy. BCSS was worse in the primary endocrine therapy group than in the surgical group (5-year BCSS rate 69·4 and 89·9 per cent respectively). This was true for all strata considered, although the difference was less in the cohort with the greatest degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact on overall survival. CONCLUSION: BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life expectancy may permit choice of women for whom surgery confers little benefit.
BACKGROUND: Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women. METHODS: Cancer registration data for 2002-2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health status on BCSS. Missing data were handled using multiple imputation. RESULTS: Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of 23 849 women (78·5 per cent) were identified as having ER-positive disease; of these, 10 087 (53·9 per cent) had surgery and 8643 (46·1 per cent) had primary endocrine therapy. BCSS was worse in the primary endocrine therapy group than in the surgical group (5-year BCSS rate 69·4 and 89·9 per cent respectively). This was true for all strata considered, although the difference was less in the cohort with the greatest degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact on overall survival. CONCLUSION: BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life expectancy may permit choice of women for whom surgery confers little benefit.
Authors: A Z de Boer; N A de Glas; P J Marang-van de Mheen; O M Dekkers; S Siesling; L de Munck; K M de Ligt; G J Liefers; J E A Portielje; E Bastiaannet Journal: Br J Surg Date: 2020-04-07 Impact factor: 6.939
Authors: Lynda Wyld; Malcolm W R Reed; Jenna Morgan; Karen Collins; Sue Ward; Geoffrey R Holmes; Mike Bradburn; Stephen Walters; Maria Burton; Esther Herbert; Kate Lifford; Adrian Edwards; Alistair Ring; Thompson Robinson; Charlene Martin; Tim Chater; Kirsty Pemberton; Anne Shrestha; Alan Brennan; Kwok L Cheung; Annaliza Todd; Riccardo Audisio; Juliet Wright; Richard Simcock; Tracy Green; Deirdre Revell; Jacqui Gath; Kieran Horgan; Chris Holcombe; Matt Winter; Jay Naik; Rishi Parmeshwar; Julietta Patnick; Margot Gosney; Matthew Hatton; Alastair M Thomson Journal: Eur J Cancer Date: 2020-11-18 Impact factor: 9.162
Authors: Willeke G van der Plas-Krijgsman; Jenna L Morgan; Nienke A de Glas; Anna Z de Boer; Charlene L Martin; Geoffrey R Holmes; Susan E Ward; Tim Chater; Malcolm W Reed; Jos W S Merkus; Thijs van Dalen; Annelie J E Vulink; Leander van Gerven; Onno R Guicherit; Eugenie Linthorst-Niers; Titia E Lans; Esther Bastiaannet; Johanneke E A Portielje; Gerrit Jan Liefers; Lynda Wyld Journal: Eur J Cancer Date: 2022-01-23 Impact factor: 9.162
Authors: Maria Burton; Kate J Lifford; Lynda Wyld; Fiona Armitage; Alistair Ring; Anthony Nettleship; Karen Collins; Jenna Morgan; Malcolm W R Reed; Geoffrey R Holmes; Mike Bradburn; Jacqui Gath; Tracy Green; Deirdre Revell; Kate Brain; Adrian Edwards Journal: Trials Date: 2021-07-13 Impact factor: 2.279
Authors: Nam P Nguyen; Ulf Karlsson; Eromosele Oboite; Julio Alvarenga; Juan Godinez; Alice Zamagni; Micaela Motta; Satya Bose; Vincent Vinh-Hung Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241