Abstract S3-07: Complication and economic burden of local therapy options for early breast cancer

Postoperative Complications After Breast Cancer Surgery are Not Related to Age

INTRODUCTION

Consensus about surgical treatment options for breast cancer in elderly patients remains elusive due to exclusion from clinical trials. Fear of complications due to increased age often is an important factor in the choice of treatment and might result in different treatment of the older patient.

METHODS

A total of 1258 female patients who underwent breast cancer surgery for primary diagnosed breast cancer in 2010-2014 were included. Incidence of postoperative complications (POCs) was compared between the younger (18-70 years, N = 1008) and older (≥71 years, N = 250) patients. Multivariate logistic regression was performed to identify the correlation between age and POCs.

RESULTS

POCs developed in 25.9% of the younger and 31.6% of the older patients (p = 0.042). In multivariable logistic regression analysis of the overall study population, age was no risk factor for POC (odds ratio 0.950, 95% confidence interval 0.640-1.410, p = 0.798). More extensive surgery (mastectomy and/or axillary lymph node dissection compared with single lumpectomy) and increased body mass index increased the odds of developing a POC. Analyses of the ≥71-year group separately revealed only type of surgery to be of influence.

CONCLUSIONS

Fear of increased risk of complications in the older patient is unjustified. Neither increased age nor high American Society of Anesthesiologists classification are predictors for developing POC. Type of surgery is the most important determinant. Choosing mastectomy while breast-conserving surgery is suitable should be discouraged, particularly in the older patient.

The rise in bilateral mastectomies: Evidence, ethics, and physician's role

This viewpoint reviews double mastectomies' trend, medical evidence and ethical considerations, as well as the role of the physician in counseling the patient. It concludes that physicians should encourage patients to pursue alternative preventive measures, and promote bilateral mastectomies only for high-risk patients for whom the potential benefits of the surgery are sufficient to justify the surgery's increased risks.