Hormone tablets instead of surgery for small breast cancers in the frail over-80s
Frail women over 80 with small hormone-sensitive breast cancers may do as well with a daily tablet as with surgery. A trial would define who can safely avoid the operation.
Older trials of primary endocrine therapy showed equal survival but more local progression; modern imaging and aromatase inhibitors change the calculus. Propose an RCT in women aged 80 and over with ER-positive tumours under 2 cm and frailty, comparing primary endocrine therapy with surgery, with quality of life and overall survival endpoints.
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
Pages like this
not linked directly; found by shared links- IdeaStop screening by life expectancy, not birthday, with a tool in the record
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Overdiagnosis and false alarms.
- IdeaGeriatrician co-management for older patients having cancer surgery
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaParallel real-world cohorts for sicker patients alongside every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaCardiometabolic screening and treatment for survivors on long-term hormone therapy
Shares Endocrine therapy (SERMs, AIs, SERDs), Older and multimorbid patients are excluded and undertreated, HR-positive / HER2-negative breast cancer.
- IdeaPragmatic trials in patients over 75 with function, not just survival, as the primary endpoint
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA defined pathway for patients with both dementia and cancer
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaA mandatory over-70s cohort with geriatric assessment in every pivotal trial
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
- IdeaWatch small kidney tumours rather than remove them, with a national registry
Shares Older and multimorbid patients are excluded and undertreated, Overdiagnosis and false alarms.