Year 2021
October 2021


Abstract Title
Revisiting surgery versus primary endocrine therapy in older women (≥65 years old) with breast cancer: a systematic review



Nanyang Technological University1, University of Nottingham School of Medicine2, Khoo Teck Puat Hospital3

Background & Hypothesis

In the older breast cancer patient, primary endocrine therapy (PET) is an alternative to primary surgical therapy (PST). Two previous reviews comparing PET to PST were conducted in 2008 and 2014. However, both reviews did not include findings on quality of life (QOL). This study aims to provide an updated review on PET versus PST in older breast cancer patients on survival, disease progression, adverse reactions and QOL outcomes.



A systematic search was performed on PubMed, Embase (Ovid), Scopus and Cochrane using subject headings and text words on (1) breast cancer in the elderly, (2) surgery and (3) primary endocrine therapy. All articles are retrospective and prospective studies comparing PET and PST in patients >65 years. Only articles published between 2000-2020 were included.


We identified 2632 articles and 14 studies (8 RCTs, 2 prospective cohort studies and 4 retrospective studies) were included in our analysis. One observational study focusing on QOL was not included in previous reviews. Two of nine studies comparing overall survival found PST superior one of seven comparing breast cancer specific survival favoured PST. Local recurrence rates were higher in PET than PST in three out of nine studies and time to local treatment failure was shorter in PET in one in three studies. Nine studies compared distant metastases and three discussed adverse events which showed equivalent outcomes. Two studies discussed QOL and showed equivalent outcomes.

Discussion & Conclusion

PST is superior to PET for local recurrence and survival. Further prospective studies are required on QOL which is currently under-reported.