Mastectomy and breast-conserving treatment have proven equally effective in terms of survival in early
breast cancer, but studies continue to provide evidence that patients undergoing breast-conserving procedures have a better quality of life (QOL). Age is not considered to be a
contraindication for breast-conserving treatment, but retrospective studies have indicated that elderly patients are less likely to be treated conservatively. In the present study, survival, QOL and treatment preference have been investigated in a multicentre, randomised clinical trial of elderly patients with early
breast cancer undergoing
mastectomy or tumour excision plus
tamoxifen. Eligible patients were aged 70 years or more and had histologically- or cytologically-confirmed operable
breast cancer. A QOL questionnaire consisting of 36 items was constructed covering 9 scales assessing different QOL domains. Patients completed their assessment between 2 and 12 months after randomisation. 136 patients (65 in the
mastectomy arm and 71 in the local excision arm) from six centres filled out a QOL form during the first year of follow-up. No significant difference in the duration of survival between the two treatment arms was observed when including patients included in the QOL sub-study (P=0.33). Patients undergoing tumour excision and
tamoxifen did not differ from those undergoing
mastectomy in terms of
fatigue, emotional functioning, fear of recurrence, social support, physical functioning and leisure time activities. However, conservatively treated patients reported fewer arm problems (P=0.04) and a shift, although borderline significant, in the direction of a benefit in body image (P=0.06). As QOL seems to be better after
conservative treatment, such treatment is to be preferred in both elderly and younger patients.