A Breast Cancer Study in Padua, Italy Shows that Surgery Gives a Higher Survival Benefit in Women ages 90-100

A retrospective study recently conducted at the Veneto Oncology Institute in Padua, Italy, indicates a higher survival benefit for breast cancer surgery for women 90 through 100 years of age in good physical condition as opposed to managing the cancer using standard non-surgical conservative methods.

According to a report by Dr. Massimo Ferrucci at the Institute who led the study:

• Veneto Oncology’s medical records for 123 breast cancer patients ages 90 through 100 (nonagenarian patients) were selected for the study
• The review covered the period of 2007 through December of 2018
• The study criteria called for the patients to have been newly diagnosed with stage 1 to 4 oligometastatic breast cancer which is more treatable
• The majority of patients were diagnosed with Stage II breast cancer
• The median age of the patients was 93
• Median overall survival from the time of diagnosis reached 54 months for those who underwent mastectomy or wide local excision
• Median overall survival for the same period reached 29 months for the non-surgical group
• Surgical patients had a recurrence rate of 12.3%

Dr. Ferrucci told MedPage Today that modern surgery and anesthesia brought about a reduction in the risk of breast cancer and are considered to be safe. The study’s findings were presented at the 25th annual session of the American Society of Breast Surgeons.

Dr. Ferrucci noted that almost half of elderly breast cancer patients do not receive optimal surgical and systemic treatments.

Looking at worldwide incidents of cancer in women, breast cancer is the most common. Over half of these women are over 60 years of age. The number of older women living to 70 or 80 years of age is increasing in tandem with the number of reported breast cancers.

When unjustifiable undertreatment occurs, it is usually attributable to fears about older patient’s age and possibly having other illnesses (comorbidities). To date, the older woman has not been adequately represented in most of the clinical trials nor have their issues been properly addressed.

Yet surgery is still the standard of care for most women. Exceptions would be if they were not candidates for surgery, do not agree to surgery, or were diagnosed as having limited quality of life and shortened life expectancy.

Adjuvant therapy administered after the primary therapy reduces the risk of the cancer returning although it has not been given sufficient attention. These therapies for example, include radiation therapy, chemotherapy, hormone therapy, and targeted, or biological therapy.

As one example of being patient centric (involving the patient in all decisions) adjusting or omitting adjuvant radiation therapy for low-risk patients has been practiced frequently.

Breast surgeon Dr. Hanh-Tam Tran who was not directly involved with the research, explains that the risk of old age increases the risk of various types of breast cancer, yet she stated that patients who are treated for invasive breast cancer usually survive.
The doctor notes that recent advancements in diagnosis together with highly individualized treatment plans, have increased recovery odds allowing older patients to live healthier and longer lives.

In the Padua trial, no substantive survival differences occurred between standard surgeries and adapted (adjusted) surgeries according to Dr. Ferrucci. However postoperative complications were somewhat higher using the standard approach. Therefore, it appears that the age-adapted approach would be the better treatment of choice for these patients.

Dr. Preeti Subhedar, who is a breast surgeon in Mount Kisco, NY said that nonagenarian women between the ages of 90 and 100 should be made aware that there are adequate non-surgical treatments that can help to control their disease.

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Last modified: April 29, 2024