Study: Older Women with Breast Cancer May Be Undertreated
October 17, 2006
By: Patricia Kowsmann
Source: Wall Street Journal
Elderly women with breast cancer who receive care in community hospitals might not be getting proper diagnosis and treatment, according to a study being published by the Journal of the American Medical Association's Archives of Surgery.
About 50% of breast-cancer patients are older than 65, and 77% of deaths from the disease occur in women older than 55, according to the October issue of the journal.
The American Cancer Society estimates that about 213,000 women in the U.S. will be found to have invasive breast cancer and about 41,000 will die of the disease this year. Breast cancer ranks second among cancer deaths in women, after lung cancer.
The study, conducted by Dr. David Litvak when he was at Michigan State University, found that mammography is underused as a screening method in older women and, once cancer is diagnosed, many of those patients aren't treated with common therapies, including radiation and chemotherapy.
"Unfortunately, part of [the problem] may be due to physicians' attitudes toward treating older people," said Dr. Litvak, now at Kaiser Permanente Medical Center of Orange County, Calif. "There is an underlying belief that older people can't tolerate treatments that we use in younger people. But as the population has aged, 80 years old now can mean that people still have 10 or more years of life expectancy."
Study researchers divided a total of 354 breast-cancer patients age 70 years or older and diagnosed between 1992 and 2002 into three age groups: from 70 to 74, 75 to 79, and older than 80.
The median tumor size and stage of disease were the same in each group.
Overall, 46% of the patients came to their physician with breast cancer that could be felt during a physical examination, researchers found. That number increased to 62% in the oldest age group, suggesting that older women are less likely to have regular mammograms.
Although 72% of all women had mammograms, they were mainly used to verify the results of the physical exam, rather than being used as a preventive tool. That percentage decreased to 60% in the group of women older than 80.
According to the study, current recommendations from official agencies on breast-cancer screening for elderly women range from an upper-age limit of 70 years to no upper-age limit. From the 354 women, over 70% were in the early stages of cancer based on primary diagnosis, but evaluation of lymph nodes to assess the cancer's progression, a common measure for younger patients, was omitted in 36% of the cases, the study found. That rose to 56% in women 80 or older.
What is more worrisome is that although about half of the women received breast-conserving surgery, rates of chemotherapy, radiation and hormonal therapy were lower than would be expected and were lowest among the oldest women. For example, while 19% of women between 70 and 74 years received chemotherapy, only 10% of those aged 75 to 79 and 5% of those older than 80 got the same treatment.
A lot of decisions are being made by both patients and physicians based on "an inaccurate perceived notion of what older people can and cannot tolerate," Dr. Litvak said.
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