Lumpectomy with tamoxifen as primary treatment for elderly women with early-stage breast cancer

Background: Appropriate therapy for women over 70 years of age with breast cancer is currently a highly debated topic. The aim of this study was to determine whether a subset of patients could be identified in which lumpectomy alone, followed by tamoxifen, would offer adequate local, regional, and long-term control of disease. Methods: A retrospective analysis of 171 women over the age of 70 with stage I or II breast carcinomas treated by the senior authors from 1984 to 1998 was undertaken. One hundred and thirty-five patients who received conventional treatment were compared with 43 patients who received lumpectomy alone followed by tamoxifen. Differences in patient and tumor characteristics and in disease outcome and complications between the two groups were analyzed. Results: The patients treated with lumpectomy and tamoxifen were significantly older (80 versus 76 years) and had significantly smaller tumors (1.4 versus 1.8 cm) than the conventionally treated patients. No significant differences were noted in comorbidities, clinical tumor size, histology, margin status, tumor differentiation, and hormone receptor status. There were no local or regional recurrences and only 1 distant recurrence (2%) in the lumpectomy with tamoxifen patients. In the conventionally treated group, 4 patients (3%) recurred locally, none regionally, and 18 patients (13%) recurred distantly. Conclusion: These data indicate that lumpectomy alone followed by tamoxifen results in an acceptable disease outcome in a subset of elderly women with breast cancer. This subset is defined by older patients with small, hormone receptor positive tumors.