Omission of surgery, primary endocrine therapy edherence, and effect of comorbidity in older women with estrogen receptor positive breast cancer by Neil Carleton, G4 student

Most women ≥70 years undergo breast surgery for primary treatment of estrogen receptor (ER) positive breast cancer. Only a small minority forego surgical intervention despite a growing body of literature, mainly from the United Kingdom (UK) and The Netherlands, where rates of primary endocrine therapy in older women reach 30%–40% [[1],[2]]. Prior randomized studies have established equivalency in overall survival between older patients receiving primary endocrine therapy versus upfront surgery [[3],[4]]. This level I evidence, however, only included women with Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 who would likely, in clinical practice, opt for surgery. Patients included in the randomized trials also tended to be younger (median age of 76), had smaller tumors, and only received tamoxifen.