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Original Contribution
February 8, 2012

Association Between Age at Diagnosis and Disease-Specific Mortality Among Postmenopausal Women With Hormone Receptor–Positive Breast Cancer

Author Affiliations

Author Affiliations: Departments of Surgical Oncology (Drs van de Water, van de Velde, Hille, Bastiaannet, and Liefers), Gerontology and Geriatrics (Drs van de Water, de Craen, Bastiaannet, and Westendorp), Medical Statistics (Dr Putter), and Medical Oncology (Dr Nortier), Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery—Breast Unit, Athens University Medical School, Athens, Greece (Dr Markopoulos); Department of Medical Oncology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, the Netherlands (Dr Seynaeve); Department of Obstetrics and Gynecology, University Hospital Freiburg, Freiburg, Germany (Dr Hasenburg); Department of Medical Oncology, University of Birmingham, Birmingham, United Kingdom (Dr Rea); Department of Gynecology, Philipps-University of Marburg, Marburg, Germany (Dr Hadji); and Department of Medical Oncology, US Oncology Research, The Woodlands, Texas (Dr Jones).

JAMA. 2012;307(6):590-597. doi:10.1001/jama.2012.84

Context In addition to classic tumor-related prognostic factors, patient characteristics may be associated with breast cancer outcome.

Objective To assess the association between age at diagnosis and breast cancer outcome in postmenopausal women with hormone receptor–positive breast cancer.

Design, Setting, and Patients Study analysis of 9766 patients enrolled in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) randomized clinical trial between January 2001 and January 2006. Age at diagnosis was categorized as younger than 65 years (n=5349), 65 to 74 years (n=3060), and 75 years or older (n=1357).

Main Outcome Measures Primary end point was disease-specific mortality; secondary end points were other-cause mortality and breast cancer relapse.

Results During median follow-up of approximately 5.1 years, there were a total of 1043 deaths. Disease-specific mortality, as a proportion of all-cause mortality, decreased with categorical age group (78% [<65 years], 56% [65-74 years], and 36% [≥75 years]; P < .001). In multivariable analyses, compared with patients younger than 65 years, disease-specific mortality increased with age for patients aged 65 to 74 years (hazard ratio [HR], 1.25; 95% CI, 1.01-1.54); and patients aged 75 years or older (HR, 1.63; 95% CI, 1.23-2.16) (P < .001). Similarly, breast cancer relapse increased with age for patients aged 65-74 years (HR, 1.07; 95% CI, 0.91-1.25 and patients aged 75 years or older (HR, 1.29; 95% CI, 1.05-1.60) (P = .06). Other-cause mortality increased with age in patients aged 65 to 74 years (HR, 2.66; 95% CI, 1.96-3.63) and patients aged 75 years or older (HR, 7.30; 95% CI, 5.29-10.07) (P < .001).

Conclusion Among postmenopausal women with hormone receptor–positive breast cancer, increasing age was associated with a higher disease-specific mortality.