Breast cancer surgery in older women : outcomes of the Bridging Age Gap in Breast Cancer study

Background In older women breast cancer (BC) surgery is often non-standard or omitted due to concerns about morbidity. The Age Gap prospective multi-centre cohort study aimed to determine factors influencing selection for and outcomes from surgery for older BC patients. Methods Women >70 with operable BC were recruited from 56 UK breast units between 2013-2018. Data on patient and tumour characteristics were correlated with type of surgery to the breast (breast conservation surgery [BCS], mastectomy) and axilla (axillary node clearance [ANC], sentinel node biopsy [SLNB] or no axillary surgery [NAS]) using univariate and multivariate analysis. Oncologic, adverse event and Quality of life (QoL) outcomes were monitored for 2 years. Results Of 3375 recruited women, surgery was performed in 2816. There were 62 bilateral tumours, giving 2854 surgical events. The median age was 76 (range 70-95). Breast surgery comprised mastectomy in 1138, BCS in 1798. Axillary surgery comprised 575 ANC, 2203 SLNB and 76 NAS. Age, frailty, dementia and comorbidities were predictors of mastectomy (RR 1.06, CI 1.05-1.08). Frailty and comorbidity were significant predictors of NAS (RR 0.91, CI 0.87-0.96). The rate of adverse events was moderate (551/2854, 19.3%) with no 30 day mortality. Long term QoL and functional independence were adversely affected by surgery. Conclusions Age, ill health and frailty all impact on surgical decision making for BC. BC surgery is safe with serious adverse events being rare and no mortality. However surgery has a negative impact on QoL and independence which must be considered when counselling patients about choices.