{"entity":{"id":"idea-prev-frail-elderly-primary-endocrine-breast","kind":"idea","name":"Hormone tablets instead of surgery for small breast cancers in the frail over-80s","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["breast-hr-positive"],"sections":["hormonal"],"technologies":["endocrine-therapy","geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-aging-comorbidity"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"800-patient pragmatic RCT.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":6},"route":"/ideas/idea-prev-frail-elderly-primary-endocrine-breast/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"hormonal","kind":"section","name":"Hormonal Therapy","route":"/fronts/hormonal/"}],"technology":[{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/"},{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}