• Marloes G M Derks, Esther Bastiaannet, Mandy Kiderlen, Denise E Hilling, Petra G Boelens, Paul M Walsh, Elizabeth van Eycken, Sabine Siesling, John Broggio, Lynda Wyld, Maciej Trojanowski, Agnieszka Kolacinska, Justyna Chalubinska-Fendler, Ana Filipa Gonçalves, Tomasz Nowikiewicz, Wojciech Zegarski, Riccardo A Audisio, Gerrit-Jan Liefers, PortieljeJohanneke E AJEADepartment of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands., van de VeldeCornelis J HCJHDepartment of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. c.j.h.van_de_velde@lumc.nl., and EURECCA Breast Cancer Group.
• Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
• Br. J. Cancer. 2018 Jul 1; 119 (1): 121-129.

BackgroundOlder patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.MethodsPopulation-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.ResultsIn total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.ConclusionsThere is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

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