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As Japan faces a rapidly aging population, the mortality rate from breast cancer among the elderly population is increasing despite significant advances in therapeutic options. Elderly patients frequently do not receive standard treatments, often due to declines in physical and cognitive functions. We investigate the differences in treatment patterns and outcomes between elderly and younger patients with metastatic breast cancer. We analyzed clinical data from the Advanced Breast Cancer Database (ABCD), maintained by the Japanese Breast Cancer Research Group. The dataset included patients registered between June 1, 2020, and October 31, 2023, encompassing clinicopathologic information such as primary or metastatic subtype, age at diagnosis of metastasis, comorbidities, sites of metastasis, treatment specifics and duration, and overall survival (OS). The study analyzed 1745 patients, with an average age at metastasis diagnosis of 60.3 years; of these, 331 (19%) were aged between 70 and 79 years, and 82 (4.7%) were 80 or older. Subtype distribution was 61% luminal, 11% luminal-HER2, 7% HER2, and 12% triple-negative breast cancer. During a median follow-up of 28.8 months, 448 deaths (26%) were observed. The three-year OS rate was notably lower at 56% for patients aged 80 and above. Among older people, there was a significant reduction in the use of intravenous treatments, BRCA analysis, and genomic panel testing. In multivariate analysis, no age-related differences were observed in the time to subsequent therapy for the first-line systemic treatment. However, OS for patients over 80 was significantly shorter than those under 80 (adjusted Hazard Ratio: 1.79, 95%CI: 1.09-2.97, p=0.02). Detailed findings will be discussed. Our investigation sheds light on the disparities in treatment patterns and outcomes for elderly metastatic breast cancer patients. Despite treatment advancements, significant gaps in accessing standard care for older people due to age-related declines remain. Targeted efforts are necessary to enhance care for this vulnerable population, with further research and interventions needed to improve outcomes and quality of life.
Mitsueda et al. (Wed,) studied this question.