Presentation (CTI)

OBJECTIVES: As populations age, older women form a growing share of breast cancer, yet whether their less intensive treatment and worse survival reflect undertreatment, appropriate de-escalation, or competing mortality remains debated. Using Czech national registries, we described the care pathway, treatment, and survival of women aged 70 years or older versus younger than 70 with early-stage breast cancer.
METHODS: We identified women with a first primary, stage I-II breast cancer (C50) diagnosed 2017-2024 in the National Czech Cancer Registry. Groups were compared on composition of first treatment (surgery, chemotherapy, endocrine therapy), multidisciplinary team (MDT) review, and centralization to comprehensive cancer centers using a population-wide healthcare claims database. Overall survival (OS) and the cumulative incidence of breast cancer death (competing risk: non-cancer death) were estimated. All analyses were descriptive and unadjusted.
RESULTS: Of 39,330 women with early-stage disease, 34.4% were aged 70 years or older. Three-year all-cause mortality was much higher in older women (10.4% vs 2.6%), yet cumulative breast cancer mortality remained low in both groups (3.7% vs 1.6%); thus non-cancer causes accounted for roughly three-quarters of the excess mortality. Older women underwent surgery (86.9% vs 97.1%) and chemotherapy (16.1% vs 45.0%) far less often, and more often received primary endocrine therapy alone (11.7% vs 2.1%); these gaps persisted within both stages (e.g., stage II surgery 80.7% vs 96.7%). MDT review (71.1% vs 75.7%) and centralization (52.8% vs 58.5%) were also lower.
CONCLUSIONS: In early-stage breast cancer, older women's markedly higher all-cause mortality largely reflected competing non-cancer mortality rather than breast cancer, alongside substantially less intensive and less centralized treatment.