Age does not predict breast cancer outcome
J. P. Crowe Jr, N. H. Gordon, R. R. Shenk, R. M. Zollinger Jr, D. J. Brumberg and J. M. Shuck
Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio.
OBJECTIVE: To determine whether age is a prognostic factor of breast cancer
and should be used to make treatment recommendations, because younger
patients are considered to have a poorer prognosis compared with that of
older patients and, thus, often receive more aggressive therapy. DESIGN: A
large group of patients with operable breast cancer, all of whom were
followed up prospectively as part of two multicenter trials. SETTING: Case
Western Reserve University, Cleveland, Ohio, was the primary hospital and
study center, with 12 participating regional institutions. PATIENTS: All
1353 patients underwent uniform local-regional therapy that consisted of a
modified radical mastectomy. Patients who were node negative were followed
up, and patients who were node positive received systemic chemoendocrine
therapy. MAIN OUTCOME MEASURES: Patients were followed up at regular
intervals for either recurrence or death. RESULTS: Patients ranged in age
from 22 to 75 years with a median age of 56 years. Younger patients had
more estrogen receptor-negative tumors (P < .0001) and a greater number
of positive lymph nodes (P < .0001). Of the 241 black patients in the
study, a greater percentage were younger compared with white patients (P
< .0001). Age was considered in a Cox's multivariate model, together
with nodes, tumor diameter, estrogen receptor content, and race. Age was
not a significant predictor of either disease-free (P = .33) or overall (P
= .30) survival. Using mixture models with covariates, the estimated
average hazards (where lambda indicates the force of mortality) of breast
cancer deaths per year were similar (P, not significant) for patients 45
years old or younger (lambda = 0.061), older than 45 years but 65 years old
or younger (lambda = 0.052), and older than 65 years (lambda = 0.061).
CONCLUSIONS: In conclusion, younger patients as a group have more
aggressive and advanced breast cancer at presentation compared with older
patients. Considered in a multivariate model, together with other
variables, age does not provide independent prognostic information and
should not be used alone for management decisions.
