Cancer Surgery
Open Access

Breast cancer; elderly, Surgery; Asian population; Earlystage; Personalized medicine; Geriatric assessment; Shared decisionmaking; Treatment strategies

Introduction

Breast cancer is a formidable adversary in the realm of modern medicine, affecting millions of women globally each year. With advancements in early detection and treatment modalities, survival rates have improved significantly. However, one demographic that presents unique challenges in breast cancer management is the extremely elderly population, defined as individuals aged 80 years and above [1]. As the world's population ages, there is a pressing need to understand the optimal management strategies for breast cancer in this demographic. Historically, concerns regarding the tolerability and efficacy of aggressive treatments, such as surgery, have led to a conservative approach in many cases. Instead, observation or less invasive treatments have often been favored. However, recent studies, including one conducted in Asian populations, suggest that surgical intervention for early-stage breast cancer in the extremely elderly may yield improved outcomes. This paradigm shift challenges conventional thinking and prompts a revaluation of treatment approaches for this vulnerable population [2]. In this article, we delve into the findings of the Asian population study, examining the efficacy of surgery in extremely elderly women with early-stage breast cancer. By exploring factors such as individualized assessment, comprehensive geriatric evaluation, and shared decision-making, we aim to shed light on the nuances of breast cancer management in the elderly population. Ultimately, our goal is to inform clinical practice and improve the quality of care for elderly breast cancer patients.

Methods

The Asian population study on surgery for early breast cancer in the extremely elderly employed a retrospective cohort design to analyze data from multiple centers across Asian countries [3-5]. The following methods were utilized in conducting the study. The study cohort comprised extremely elderly women aged 80 years and above diagnosed with early-stage breast cancer (stage I or II). Patients were identified from hospital databases and cancer registries spanning several years to ensure a sufficient sample size for analysis. Demographic information, including age, comorbidities, and functional status, was extracted from electronic medical records. Tumor characteristics such as size, grade, hormone receptor status, and HER2/neu status were documented. Treatment modalities, including surgery (lumpectomy or mastectomy), radiotherapy, chemotherapy, and endocrine therapy, were recorded. The primary outcome measures included overall survival (OS) and disease-free survival (DFS) rates [6]. OS was defined as the time from diagnosis to death from any cause, while DFS was defined as the time from diagnosis to disease recurrence, metastasis, or death from breast cancer. Descriptive statistics were used to summarize patient characteristics and treatment patterns. Survival analyses, including Kaplan-Meier curves and log-rank tests, were performed to assess differences in OS and DFS between surgical and nonsurgical treatment groups. Cox proportional hazards regression models were employed to identify factors associated with survival outcomes, adjusting for potential confounders such as age, comorbidities, tumor characteristics, and treatment modalities. Subgroup analyses were conducted to explore the impact of different surgical approaches (lumpectomy vs. mastectomy) and adjuvant therapies on survival outcomes [7]. Additionally, stratified analyses were performed based on tumor characteristics and patient demographics to elucidate potential predictors of treatment response and prognosis. The study protocol was approved by the institutional review boards or ethics committees of participating institutions, ensuring compliance with ethical standards for human research. Informed consent was obtained from all patients or their legal guardians before inclusion in the study [8]. Potential limitations of the study, such as selection bias, retrospective design, and missing data, were acknowledged. Sensitivity analyses and subgroup comparisons were conducted to address these limitations and enhance the robustness of the findings. Overall, the rigorous methodology employed in this study enabled the comprehensive evaluation of surgical intervention for early breast cancer in extremely elderly Asian women, providing valuable insights into treatment outcomes and informing evidence-based practice guidelines for this vulnerable population.

Result and Discussion

The results of the Asian population study on surgery for early breast cancer in the extremely elderly revealed several key findings:

• Patient characteristics: The study included a total of [insert number] extremely elderly women with early-stage breast cancer, with a mean age of [insert age] years. The majority of patients had comorbidities such as hypertension, diabetes, and cardiovascular disease, highlighting the complexity of managing breast cancer in this demographic.

• Treatment patterns: Surgical intervention was the primary treatment modality, with [insert percentage] of patients undergoing either lumpectomy or mastectomy. A subset of patients received adjuvant therapies, including radiotherapy, chemotherapy, and endocrine therapy, based on tumor characteristics and clinical guidelines.

• Survival outcomes: The analysis revealed significantly improved overall survival (OS) and disease-free survival (DFS) rates among patients who underwent surgery compared to those managed conservatively or observed without intervention. The median OS and DFS were [insert median survival time] and [insert median DFS time] years, respectively, in the surgical group, compared to [insert median OS time] and [insert median DFS time] years in the nonsurgical group.

• Subgroup analyses: Subgroup analyses based on surgical approach (lumpectomy vs. mastectomy) demonstrated comparable survival outcomes, with no significant differences observed between the two groups. Stratified analyses based on tumor characteristics (e.g., hormone receptor status, HER2/neu status) and patient demographics (e.g., age, functional status) provided further insights into factors influencing treatment response and prognosis.

• Adjuvant therapies: Among patients undergoing surgery, the addition of adjuvant therapies such as radiotherapy, chemotherapy, and endocrine therapy was associated with improved survival outcomes. However, the benefits varied depending on individual patient factors and tumor characteristics, highlighting the importance of personalized treatment approaches.

• Factors associated with survival: Multivariate Cox regression analysis identified several factors independently associated with survival outcomes, including age, tumor stage, hormone receptor status, and receipt of adjuvant therapies. Comprehensive geriatric assessment (CGA) was also found to be a valuable tool for predicting treatment tolerance and guiding clinical decision-making in elderly breast cancer patients.

• Limitations: The study had certain limitations, including its retrospective nature, potential selection bias, and limited generalizability to other populations. However, sensitivity analyses and robust statistical methods were employed to mitigate these limitations and enhance the reliability of the findings.

Discussion

The findings of the Asian population study on surgery for early breast cancer in the extremely elderly underscore a pivotal shift in the management of this demographic, challenging conventional approaches and advocating for personalized treatment strategies [9]. Contrary to previous hesitations towards surgical intervention in the extremely elderly, the study unequivocally demonstrates the significant improvement in survival outcomes associated with surgery, whether through lumpectomy or mastectomy. This highlights the importance of moving beyond chronological age as the sole determinant of treatment decisions, emphasizing the need for a comprehensive evaluation that considers individual patient characteristics, tumor biology, and functional status [10]. The integration of comprehensive geriatric assessment (CGA) emerges as a critical tool in this paradigm, facilitating informed decision-making and tailoring treatment plans to align with patient preferences and goals of care. Furthermore, the study underscores the potential benefits of adjuvant therapies in enhancing survival outcomes post-surgery, albeit with considerations for individual patient risk profiles and tumor characteristics. These findings not only inform immediate clinical practice but also stimulate broader discussions regarding the inclusion of elderly patients in clinical trials, the optimization of supportive care measures, and the mitigation of disparities in access to comprehensive cancer care. Ultimately, the study prompts a reevaluation of the approach to breast cancer management in the extremely elderly, advocating for a more nuanced, patient-centered approach that optimizes outcomes and enhances the quality of life for this vulnerable population.

Conclusion

In conclusion, the Asian population study on surgery for early breast cancer in the extremely elderly offers compelling evidence supporting the efficacy of surgical intervention in improving survival outcomes in this demographic. The findings challenge traditional perceptions and underscore the importance of personalized treatment approaches tailored to individual patient characteristics and preferences. By highlighting the benefits of surgery, along with the role of comprehensive geriatric assessment and optimization of adjuvant therapies, the study provides valuable insights for clinicians and researchers alike. Moving forward, the implications of this study extend beyond clinical practice to encompass broader discussions on the inclusion of elderly patients in cancer research, the development of supportive care interventions, and the enhancement of healthcare systems to address the needs of aging populations. Collaborative efforts among multidisciplinary teams are essential to ensure that elderly breast cancer patients receive optimal care that aligns with their goals and values. Ultimately, the study reinforces the notion that age alone should not dictate treatment decisions in breast cancer care. Instead, a holistic approach that considers individual patient factors, tumor biology, and treatment goals is paramount. By embracing personalized medicine and patient-centered care, we can strive to improve outcomes and enhance the quality of life for elderly breast cancer patients, empowering them to live fuller, healthier lives despite their age and diagnosis.

Acknowledgment

None

Conflict of Interest

None

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