Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the Age Gap Trial


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Irene Athanasiou1,Malcolm Reed2,Anne Shrestha3,Kwok Leung Cheung4,Riccardo Audisio5,Lynda Wyld3
1Doncaster and Bassetlaw Teaching Hospitals,2Brighton and Sussex Medical School,3University of Sheffield,4School of Medicine, University of Nottingham,5University of Liverpool

Abstract

Background

Age related practice variance is widespread in early breast cancer (EBC) management. The Age Gap cohort study has examined comorbidity and frailty adjusted UK practice across all domains of treatment in women >70 with EBC.  This abstract presents data from the sub-group who underwent oncoplastic and reconstructive procedures.  

Method

The Age Gap study is a multicenter observational study which has recruited 3000 women >70 years of age with EBC recruiting between January 2014 – June 2017 at 54 sites. Data were collected on baseline health, fitness and frailty, cancer characteristics, treatment, quality of life and adverse events.

Results

Reconstructive surgery was performed on 31/924 (3.4%) women having mastectomy.  This percentage is slightly higher than the UK National Mastectomy and Reconstruction Audit (2010) at 2.5%.   9 were implant only, 16 implant and ADM/dermal sling and 4 DIEP flaps. Median age of the reconstructed cohort was 73 (range 70-82) versus 77 (70 -101) for the whole population (P<0.05). Median Charlson comorbidity score was 3 (3-8) versus 4 (3-17) (P<0.05) and ADL frailty score was 20 (19-20) versus 20 (1-20) (P<0.05). The 30-day mortality was zero. There were 17 early local complications (7 seromas, 2 haematomas, 5 infections and 3 flap necrosis), no systemic complications.  There were 3 longer term complications: 1 functional impairment, 2 chronic pain. Similar findings were seen with therapeutic mammoplasty procedures with 43/1406 (3%) undergoing breast conservation. Age, fitness and frailty characteristics were similarly skewed towards younger, fitter women and outcomes were similarly good. 

Conclusion

Oncoplastic and reconstructive surgery may be safely performed in a selected group of fit older women with moderate morbidity and no mortality. The low reconstruction rate in this population may reflect patient/surgeon preferences and whilst there is no evidence to preclude oncoplastic procedures, careful audit is required to ensure patient safety.