Lack of Survival Gain for Elderly Women with Breast Cancer

Background. The number of elderly women with breast cancer is increasing and will become a major health concern. However, little is known about the optimal treatment for this age group. The aim of this study was to describe time trends for the overall Dutch breast cancer cohort with an emphasis on differences between young and elderly patients. Methods. All adult female patients diagnosed in 1995–2005 were selected from the Netherlands Cancer Registry. Relative excess risks for death (adjusted for stage, histology, treatment, and grade) were estimated using a multivariate generalized linear model with a Poisson distribution, based on collapsed relative survival data, using exact survival times. Results. Overall, 127,805 patients were included. Treatment of patients aged ≥75 years changed significantly over time: they received less surgery, more adjuvant hormonal treatment and chemotherapy, and more hormonal treatment without surgery. In contrast to younger patients, the relative survival did not improve significantly over time for elderly patients. With increasing age, the observed–expected death ratio decreased to almost 1.0. Conclusion. Survival for elderly patients with breast cancer did not improve significantly. Observed–expected death ratios in the elderly are close to 1, indicating that excess mortality is low. Elderly patients with breast cancer have a higher risk for overtreatment and undertreatment, with a delicate therapeutic balance between breast cancer survival gain and potential toxicities. To improve breast cancer survival in the elderly, a critical reappraisal is needed of costs and benefits of hormonal as well as other treatments, and better selection of patients who can benefit from available therapies is warranted. 摘要 背景. 乳腺癌老年患者日益增多，已成为一个重点关注的健康问题。然而，该年龄段患者群体的最佳治疗知之甚少。本研究旨在明确荷兰国内乳腺癌的总体发病年龄趋势，着眼于年轻患者与老年患者的内在差异。 方法. 研究对象为荷兰癌症登记处记录的1995～2005年间所有确诊的乳腺癌成年女性患者。采用确切生存时间，基于相对存活率的组合数据，运用Poisson分布多变量广义线性模型评估（经过分期、组织学、治疗及分级调整后的）死亡的相对超额风险。 结果. 共纳入127,805例患者。年龄≥75岁患者的治疗模式随时间进程而显著变化：较少接受手术治疗，更易接受激素辅助治疗及化疗、或单纯激素治疗。相对于年轻患者，老年患者的相对存活率并未随时代发展明显改善。随着年龄增长，观察/预期死亡比几乎降低至1.0。 结论. 乳腺癌老年患者的生存无明显改善。老年患者的观察/预期死亡比接近于1，表明超额死亡率低。老年乳腺癌患者过度治疗或治疗不足的风险较高，治疗所能得到的生存获益与其潜在毒性间存在微妙的平衡。为了改善老年患者的生存，对激素治疗及其他疗法的成本效益进行重新评估，当务之急是有效筛选出可从现有治疗模式中获益的患者。 The relative survival of breast cancer patients diagnosed in 1995–2005 from the Netherlands Cancer Registry was examined and stratified by age group. In contrast to younger patients and in spite of similarly intensified treatment, the