Time trends in the outcome of elderly patients with breast cancer.

Mortality rates for breast cancer are improving in most countries. Life expectancy is also improving, and as age is the major risk factor for the development of breast cancer, we sought to determine whether survival of elderly women with breast cancer has improved over the past 20 years in our institution. In a retrospective study using a prospectively maintained database, we identified 950 women aged > or =70 years diagnosed with breast cancer between 1980 and 2000. Overall survival of patients was compared between two different time cohorts--those diagnosed from 1980 to 1990 and from 1991 to 2000--and between three age cohorts, 70-74, 75-79, and 80+ years. In all age groups, advanced stage, the need for mastectomy, and having chemotherapy were associated with a worse outcome on univariate analysis. Endocrine therapy (tamoxifen) was given to 60-70% of all age groups. After adjustment for clinical stage, we found no significant improvement in survival between the two time cohorts in any age groups. Compared with an age-matched group in the general population, these elderly breast cancer patients have a 62% increased risk of death. The results are likely to reflect lack of data to promote treatment guidelines. More clinical trials for older women are needed, if the benefits of recent advances in the management of this disease are to be extended to the over 70s. These data should, however, act as a benchmark for future audits.