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Evidence summaries

Surgery or Tamoxifen for Primary Breast Cancer in Elderly Women

Surgery either alone or combined with tamoxifen appears to control primary breast cancer better than tamoxifen alone in women aged 70 years and over but does not extend survival. Level of evidence: "B"

A Cochrane review [Abstract] 1 included data from 7 studies. Data, based on an estimated 1081 deaths in 1571 women, did not show a statistically significant difference in favour of either surgery or primary endocrine therapy in respect of overall survival. However, there was a statistically significant difference in terms of progression-free survival, which favoured surgery with (474 participants) or without endocrine therapy (164 participants). The hazard ratios (HRs) for overall survival were: HR 0.98 (95% confidence interval (CI) 0.81 to 1.20, P = 0.85; 3 trials, 495 participants) for surgery alone versus primary endocrine therapy; HR 0.86 (95% CI 0.73 to 1.00, P = 0.06; 3 trials, 1076 participants) for surgery plus endocrine therapy versus primary endocrine therapy. The HRs for progression-free survival were: HR 0.55 (95% CI 0.39 to 0.77, P = 0.0006) for surgery alone versus primary endocrine therapy; HR 0.65 (95% CI 0.53 to 0.81, P = 0.0001) for surgery plus endocrine therapy versus primary endocrine therapy (each comparison based on only one trial).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Hind D, Wyld L, Beverley CB et al. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev 2013;(1):CD004272. [PubMed]

Primary/Secondary Keywords