Osório F, et al. J Breast Cancer. 2021 Dec;24(6):542-553. https://doi.org/10.4048/jbc.2021.24.e45

(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on a comprehensive geriatric assessment, to guide individualized treatment decision-making. (2) Methods: A descriptive analysis of older adults with BC treated from January 2021 to December 2022 was performed. Data were analyzed based on anonymized electronic medical records. (3) Results: Of 123 patients (mean age 84.0 ± 5.6 years), 122 (99.2%) were women. The mean G8 screening score was 12.1 ± 2.5. Most had functional dependence (69.9% Barthel Index, 81.3% Lawton/Brody Scale) and a moderate-to-high risk of falling (76.4% Tinetti index). Cognitive impairment and malnutrition risk were present in 15.4% and 30.1%, respectively. Prehabilitation inclusive strategies led to adapted treatment in 55.3% of cases. Endocrine therapy, surgery, radiotherapy, and chemotherapy was used in 99.2%, 56.1%, 35.0%, and 8.9% of patients, respectively. (4) Conclusions: Our comprehensive oncogeriatric strategy promotes personalized oncologic treatment, improves outcomes by addressing frailty, and enhances treatment tolerability in older patients with BC, validating the expansion of this combined team approach to other cancer types and institutions.

Age as a breast cancer (BC) prognostic factor remains debatable. Several studies have investigated clinicopathological features at different ages, but few make an age group direct comparison. The European Society of Breast Cancer Specialists quality indicators (EUSOMA-QIs) allow a standardized quality assurance of BC diagnosis, treatment, and follow-up. Our objective was to compare clinicopathological features, compliance to EUSOMA-QIs and BC outcomes in three age groups (≤45 years, 46–69 years, and ≥70 years). Data from 1580 patients with staged 0–IV BC from 2015 to 2019 were analyzed. The minimum standard and desirable target on 19 mandatory and 7 recommended QIs were studied. The 5-year relapse rate, overall survival (OS), and BC-specific survival (BCSS) were also evaluated. No meaningful differences in TNM staging and molecular subtyping classification between age groups were found. On the contrary, disparities in QIs compliance were observed: 73.1% in ≤45 years and 46–69 years women vs. 54% in older patients. No differences in loco-regional or distant progression were observed between age groups. Nevertheless, lower OS was found in older patients due to concurrent non-oncological causes. After survival curves adjustment, we underscored evidence of undertreatment impacting BCSS in ≥70 years women. Despite a unique exception—more invasive G3 tumors in younger patients—no age-specific differences in BC biology impacting outcome were found. Although increased noncompliance in older women, no outcome correlation was observed with QIs noncompliance in any age group. Clinicopathological features and differences in multimodal treatment (not the chronological age) are predictors of lower BCSS.

Introduction: The management of older patients with breast cancer remains controversial. The difficult assessment of ageing idiosyncrasies and the insufficient evidence of therapeutic guidelines can lead to undertreatment. Our goal was to measure undertreatment and assess its impact on survival.Materials and methods: Consecutive patients with breast cancer aged 70 years or older were prospectively enrolled in 2014. Three frailty screening tools (G8, fTRST, GFI) and two functional status scales (KPS, ECOG-PS) were applied. Disease characteristics, treatment options and causes of mortality were recorded in a 5-year follow-up. We defined undertreatment and correlated its survival impact with frailty. Results: A total of 92 patients were included. Median age was 77 (range 70-94) years. The prevalence of frailty was discordant (G8: 41,9%, fTRST: 74.2%, GFI: 32.3%). A low-risk disease was not found (51.2% were N+) probably due to a late diagnosis (76.1% based on self-examination). Thirty-three patients (35.6%) died 15 of them from breast cancer. We found a considerable high proportion (53.3%) of undertreatment, which had a frailty-independent negative impact on 5-year survival (HR=5.1 [95% CI: 2.1-12.5]). Additionally, omission of surgery had a frailty-independent negative impact on overall survival (HR=3.9 [95% CI: 1.9-7.9]). Conclusion: Breast cancer treatment in older adults ought to be individualized. More important than assessing frailty (not to treat) is essential to be aware of the risk-benefit profile and the patient's well-informed willingness to be treated. The undertreatment in daily practice is frequent and might have, as we report, a negative impact on survival.