# Hormone tablets instead of surgery for small breast cancers in the frail over-80s

Source: https://onco.cc/ideas/idea-prev-frail-elderly-primary-endocrine-breast/  
OnCo record `idea-prev-frail-elderly-primary-endocrine-breast` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Primary endocrine therapy is non-inferior for overall survival at five years and superior for quality of life and independence.
- Rationale: Competing mortality dominates; post-surgical functional decline is common in the frail.
- Proposed test: 800-patient pragmatic RCT.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Hormonal Therapy](https://onco.cc/fronts/hormonal/)
- technologies: [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

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