Breast cancer is the top cancer among women in Singapore and an estimate of 1 in 16 Singaporean women will develop breast cancer by the age of 80 with a life-time risk of 6.5%. The incidence rate is expected to rise with increasing life expectancy and an ageing population.
The treatment and management of breast cancer in the elderly is generally differs from the treatment provided to younger women. As a result, there is a considerable controversy over what constitutes appropriate care for older women. In short, the controversy is reflected in the persistence of age-dependent variations in care over time, leading to older women being less likely to receive definitive care for breast cancer.[1]
…surgery should always be considered … even among elderly patients… and performed expeditiously…
Now a study conducted by National Cancer Centre Singapore (NCCS) has shown that age is not necessarily a contraindication to breast cancer surgery. The results of the study suggest that these surgeries may be safely performed for women aged 80 years and above. Led by Ong Kong Wee, MBBS, FRCSEd, PhD, a Senior Consultant in the Division of Surgical Oncology, Veronique Tan, MBBS, MMed (Surgery), MSc, FRCS Ed, Consultant, and Lee Chee Meng, MD, Resident Doctor. The study explores the safety of breast cancer surgery in women aged 80 years and above.
A retrospective analysis was performed on 109 elderly women who underwent surgery in NCCS and Singapore General Hospital (SGH) from 2001 ? 2010. Most patients were assessed to be fit for surgery under the American Society of Anesthesiologists (ASA) physical classification status with 75% of patients having an ASA physical status of 1 or 2.[2]
Although approximately 80% of patients had 1 ? 4 co-existing medical problems such as hypertension, dyslipidemia and diabetes mellitus, there were no deaths recorded following the breast surgery. More than 60% of patients recovered without any complications, while only 3% developed major complications but recovered subsequently. The average length of stay in the hospital was 3 days.
Dispelling misconceptions
“The results of this study are important as they dispel the misconception and fear among the public that surgery for elderly patients is unsafe and has a high complication rate”, Ong said. “Surgery is the most important modality in the treatment of breast cancer. It also relieves symptoms in patients who have tumours that do not respond to other therapies. Elderly patients should not be deprived of such treatment options.”
“Treatment options outside of surgery would only control the disease. The cancer cells may develop resistance to these treatments over time, and when patients require a salvage surgery later, it may result in even more complications with lower success rate,” Veronique Tan, NCCS Consultant noted.
Early detection and effective treatment is very important. “For elderly patients,” Ong added, “Surgery should always be considered in even among elderly patients and performed expeditiously.”
For more information:
[1] Bernardi D, Errante D, Gallligioni E, Crivellari D, Bianco A, Salvagno L, Fentiman IS.Treatment of breast cancer in older women. Acta Oncol. 2008;47(2):187-198.
[Article][PubMed]
[2] American Society of Anesthesiologists (ASA) physical classification status is a universally accepted score used to assess a patient?s fitness for surgery. ASA Physical Status 1 refers to a normal healthy patient while Status 2 refers to a patient with mild systemic disease. Last accessed, September 4, 2015 [Webarticle]
