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.
A large group of patients with operable breast cancer, all of whom were followed up prospectively as part of two multicenter trials.
Case Western Reserve University, Cleveland, Ohio, was the primary hospital and study center, with 12 participating regional institutions.
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.
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 λ indicates the force of mortality) of breast cancer deaths per year were similar (P, not significant) for patients 45 years old or younger (λ=0.061), older than 45 years but 65 years old or younger (λ=0.052), and older than 65 years (λ=0.061).
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.(Arch Surg. 1994;129:483-488)