An analysis of data from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial showed that the older a woman is at diagnosis of hormone-sensitive breast cancer, the greater her chance of distant recurrence over time. Distant recurrence refers to cancer that has spread to a part of the body beyond the breast and regional lymph nodes.
The trial investigators believe these findings suggest that relatively fit women diagnosed later in life should more often be considered for treatment with systemic therapies, such as chemotherapy. Systemic therapy is medicine that reaches cells all over the body, with the goal of eliminating cancer.
In many studies, researchers have compared the outcomes of premenopausal and postmenopausal women with breast cancer. However, few studies exist on the affect of age at diagnosis on breast cancer outcome after menopause. Study researchers used the TEAM trial data to explore the relationship of breast cancer recurrence to age at diagnosis in women with hormone-sensitive cancers.
The TEAM trial recruited 9,779 postmenopausal women with hormone-sensitive, early-stage breast cancer. The women were given the aromatase inhibitor exemestane (Aromasin) once daily for 5 years, or tamoxifen for 2.5 to 3 years, followed by exemestane for 2 to 2.5 years for a total of 5 years of treatment. If participants needed chemotherapy or radiation, it was completed before the trial therapy. The TEAM trial investigators hoped to determine which course of treatment led to longer recurrence-free survival (RFS), the time from the start of treatment to breast cancer coming back.
Overall, TEAM showed no difference in RFS between the treatment arms, which gave the current study’s investigators a balanced group of women to analyze for age at diagnosis.
Researchers grouped the women by age at diagnosis as follows:
- Younger than 65 years old
- 65–74 years old
- 75 years or older
They collected data on three types of recurrence:
- locoregional recurrence, or cancer that comes back in the same breast or nearby lymph nodes
- distant recurrence, or cancer that spread to other parts of the body, such as the lungs or brain
- contralateral recurrence, or cancer that develops in the opposite breast
In total, data on 9,766 women were available. The analysis showed
- incidents of locoregional and contralateral recurrence were similar across all age groups
- incidents of distant recurrence increased as age increased, with women under 65 experiencing a 7.6 percent rate increase, women 65–74 an 8.1 percent rate increase, and women 75 and older a 9.6 percent rate increase.
In the TEAM trial, chemotherapy was given to women diagnosed at older ages less often than to women diagnosed at younger ages. Based on this, the researchers believe the higher rate of distant recurrence in women over 75 may be related to use of chemotherapy less often in women of this age group, and that some of these women may benefit from chemotherapy treatment.
No data was available to show whether women of any age group took their hormonal therapy as directed during this study. Forgetting to take hormonal therapy or stopping therapy entirely may increase a woman’s chance of cancer returning.
Findings of this exploratory study are not considered conclusive until confirmed by future research.
What This Means for You
The higher rate of cancer recurrence experienced by women diagnosed over age 75 in this analysis suggests that women of this age group may need different or better treatments for early-stage breast cancer. If you are a woman over 75 with hormone-sensitive breast cancer and are interested in how treatment with chemotherapy may benefit you, talk with your doctor. If you are newly diagnosed and your treatment plan does not include chemotherapy, it’s OK to ask your healthcare team about the decision.
More research is needed to fully understand why the rate of distant recurrence rises with age at diagnosis. Other factors, such as tumor characteristics and remembering to take hormonal therapy every day, may have an impact on recurrence rates. This study highlights the need for further evaluation of chemotherapy use in older women.
For more information about making treatment decisions, see LBBC’s Guide to Understanding Treatment Decisions.
Van de Water, W, Seynaeve, C, Bastiaannet, E, et al. Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: A tamoxifen exemestane adjuvant multinational study analysis. The Oncologist. 2013; 18(1):8-13