Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: There is little clinical evidence to guide treatment decisions for ductal carcinoma in situ (DCIS) in older women. This study evaluated how the management of DCIS in women aged 70 or more compared with women aged 50-69 in England and Wales. METHOD: The study identified women aged ≥50 years with new unilateral DCIS diagnosed between 2014 and 2016 from linked cancer registration and routine hospital datasets for England and Wales. Rates of surgery and adjuvant radiotherapy were examined by age, deprivation, fitness measures (comorbidity and frailty), method of presentation and tumour grade using multilevel logistic regression. RESULTS: 12,716 women were diagnosed with unilateral DCIS between 2014 and 2016, of whom 2,754 (22%) were aged ≥70 years and 74% were screen detected. High grade DCIS was common, irrespective of age and method of presentation. Fewer women aged ≥70 had surgery compared to women aged 50-69 (81% vs. 94%), which was only partly explained by poor fitness. Use of radiotherapy following breast conserving surgery was strongly associated with grade, and was received by less than 16% of all patients with low grade tumours. Over 70% of women aged 50-69 with high grade DCIS received radiotherapy, but this fell to 35% among women aged ≥80. Use of radiotherapy was not associated with patient fitness. CONCLUSION: Treatment decisions for women with DCIS varied by age at diagnosis. Lower rates of surgery and adjuvant radiotherapy in older women were only partly explained by patient fitness. Better evidence is needed to aid treatment selection for older women with DCIS.

Original publication

DOI

10.1016/j.ejso.2019.02.034

Type

Journal article

Journal

Eur J Surg Oncol

Publication Date

08/2019

Volume

45

Pages

1378 - 1387

Keywords

Breast cancer, DCIS, Geriatric oncology, Age Factors, Aged, Aged, 80 and over, Breast Neoplasms, Carcinoma in Situ, Carcinoma, Intraductal, Noninfiltrating, Clinical Decision-Making, Cohort Studies, Combined Modality Therapy, Disease-Free Survival, England, Female, Geriatric Assessment, Humans, Logistic Models, Mastectomy, Segmental, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness, Neoplasm Staging, Prognosis, Radiotherapy, Adjuvant, Registries, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, Wales