The use of surgery in the treatment of ER+ early stage breast cancer in England: Variation by time, age and patient characteristics

P. Richards*, S. Ward, J. Morgan, C. Lagord, M. Reed, K. Collins, L. Wyld

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Aim To assess whether the proportion of patients aged 70 and over with ER+ operable breast cancer in England who are treated with surgery has changed since 2002, and to determine whether age and individual level factors including tumour characteristics and co-morbidity influence treatment choice. Methods A retrospective cohort analysis of routinely collected cancer registration data from two English regions (West Midlands, Northern & Yorkshire) was carried out (n = 17,129). Trends in surgical use over time for different age groups were assessed graphically and with linear regression. Uni- and multivariable logistic regressions were used to assess the effects of age, comorbidity, deprivation and disease characteristics on treatment choice. Missing data was handled using multiple imputation. Results There is no evidence of a change in the proportion of patients treated surgically over time. The multivariable model shows that age remains an important predictor of whether or not a woman with ER+ operable breast cancer receives surgery after covariate adjustment (Odds ratio of surgery vs no surgery, 0.82 (per year over 70)). Co-morbidity, deprivation, symptomatic presentation, later stage at diagnosis and low grade are also associated with increased probability of non-surgical treatment. Conclusion Contrary to current NICE guidance in England, age appears to be an important factor in the decision to treat operable ER+ breast cancer non-surgically. Further research is needed to assess the role of other age-related factors on treatment choice, and the effect that current practice has on survival and mortality from breast cancer for older women.

Original languageEnglish
Pages (from-to)489-496
Number of pages8
JournalEuropean Journal of Surgical Oncology
Issue number4
Publication statusPublished - 1 Apr 2016

Bibliographical note

Funding Information:
This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme ( RP-PG-1209-10071 ). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Publisher Copyright:
© 2016 Elsevier Ltd.


  • Breast cancer
  • Comorbidity
  • Elderly
  • Retrospective study
  • Surgery


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