Immediate Surgery Can Improve Long-Term Outcomes in Older Breast Cancer Patients

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Immediate surgery can improve outcomes among women age 70 and older who have operable breast cancer and are not receiving radiotherapy:
  • Results of the meta-analysis showed that patients who had immediate surgery:
    • Had lower rates of local recurrence early on, when compared to patients who had delayed surgery:
      • With longer follow-up, patients who had undergone surgery immediately also had lower rates of distant recurrence and breast cancer death
  • The meta-analysis included data from three trials encompassing 1082 women with breast cancer who were at least 70 years of age and had a median of 5 years on study:
    • The trials were all designed to compare immediate surgery to deferral of surgery until after progression, in the absence of radiotherapy
  • Results showed that, among patients with node-negative disease:
    • The rate of local recurrence at 5 years was 14.4% in patients who received tamoxifen plus surgery and 45.4% in patients who received tamoxifen alone (rate ratio [RR], 0.25; 95% CI, 0.19-0.34; P <.00001).
  • Among patients with node-positive disease:
    • The rate of local recurrence at 5 years was 6.8% in those treated with tamoxifen plus surgery and 48.1% in patients receiving tamoxifen alone (RR, 0.18; 95% CI, 0.11-0.29; P <.00001)
  • Immediate surgery leads to a very great reduction in the rates of local recurrence, and the curves separate immediately:
    • So that benefit is seen immediately, irrespective of nodal status, with really quite large absolute differences at 5 years
  • The study also found lower rates of distant recurrence and breast cancer death among patients who received immediate surgery:
    • However, those benefits only became apparent with longer follow-up:
      • The rate of distant recurrence at 15 years was 37.0% in patients who received tamoxifen plus surgery and 51.3% in patients who received tamoxifen alone (RR, 0.72; 95% CI, 0.57-0.90; P =.003)
      • The rate of breast cancer death at 15 years was 34.2% in patients who received tamoxifen plus surgery and 48.9% in those who received tamoxifen alone (RR, 0.68; 95% CI, 0.54-0.86; P =.002).
  • References:
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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