Older women who have breast-conserving surgery (BCS) without lymph node biopsy or radiation therapy have poorer survival rates than those who have this procedure plus biopsy, radiation therapy, or both, according to results of a large retrospective study reported at the Department of Defense Breast Cancer Research Program meeting in Orlando, Florida.

"We focused our study on women age 65 and older because even though breast cancer risk rises with age, appropriate treatment for cancer generally decreases with age," explained Xianglin Du, M.D., Ph.D., University of Texas Medical Branch and Sealy Center on Aging, Galveston, TX.

The Galveston team matched treatment with outcomes in two databases for 31,618 women who had BCS, also called lumpectomy, for early-stage breast cancer. Over 27% of these women, or 9,006, had BCS without nodal biopsy, and 74% of these women were at least 65 years old. Of the women who had BCS without biopsy, 62% had no radiation therapy and 98% had no chemotherapy. Numerous clinical trials have documented that post-surgical chemotherapy is appropriate for breast cancer patients only to the age of 69, but there are no such age restrictions for radiation therapy or hormone therapy.

Nodal biopsy was strongly associated with higher seven-year survival rates and higher rates of post-surgical radiation or chemotherapy to kill any errant cancer cells. Survival rates were similar for women who had either nodal biopsy or radiation therapy and those who had both procedures, reported Du.

"Survival of older breast cancer patients hasn't improved for 20 years. Our study suggests that one key reason may be the growing popularity of BCS for early-stage disease without nodal dissection, which can lead to under-staging and under-treatment, ultimately leading to higher recurrence and higher mortality," Du concluded.

Dr. Du cautioned that the study is limited by his group's inability to control for post-surgical hormone therapy (e.g. tamoxifen for post-menopausal women with estrogen receptor-positive tumors), because the databases lacked good information on that factor. "Nevertheless, the literature suggests that there's still a large proportion of women who don't receive hormone therapy," he said.

SOURCE:
Department of Defense Breast Cancer Research Program meeting, Orlando, Florida, September 26, 2002