Older breast cancer patients receiving care in a community hospital setting may be under-diagnosed and under-treated, according to the October issue of Archives of Surgery.

Age and breast cancer rates: Approximately 50 percent of breast cancer patients are 65 years and older and 35 percent are older than 70. Statistics also indicate that 77 percent of breast cancer deaths occur after 55. 

The study method: David A. Litvak, M.D. and Rajeev Arora, M.D. used a tumor registry database to identify 354 women age 70 or older who had been diagnosed with breast cancer at a community hospital. The study involved women diagnosed between 1992 and 2002. The researchers studied the women as a group and in addition, divided them into three age groups: ages 70 to 74 (136 patients), 75 to 79 (115 patients) and 80 or older (103 patients).

The study's findings: The authors identified differences in diagnostic procedures and omissions of treatment in elderly patients compared to younger breast cancer patients.

In the elderly patient group breast cancer was diagnosed primarily through physical exam. Almost half of the patient group had breast cancer that could be felt during a physical examination. While 72% of all the women and 60% of those age 80 and older had mammograms, mammograms only identified undetected breast cancer in half of the patients, and only in 38% of those 80 years or older. More than than 70% of patients were in the early stages of cancer (stages I and II) at , but evaluation of the lymph nodes was omitted in 36% of the cases, including 56% in women over 80.

Approximately 50% of the women identified in the study received breast-conserving surgery. However, other forms of treatment such as , radiation or hormonal therapy were utilized less often than would be expected when compared to treatment for younger patients. Adjuvant treatment was less frequently used in elderly patients, even when indicated by staging or pathology. In particular, 20% of patient population had cancer which had spread to lymph nodes or had estrogen receptor-positive tumors, but only 29% of this subset of patients received chemotherapy. In the oldest patients (80 years or older), only 17% of patients received chemotherapy in the presence of lymph node disease. The oldest patients had the smallest percentage of the adjuvant treatments

According to the study, one reason older women are being untreated is the difficulty in identifying appropriate treatments for older patients. Many patients are less likely to tolerate treatments due to concurrent serious illness.  Questions also remain about the best screening protocols for elderly women. Some current guidelines suggest that women stop having mammograms at age 70.

The study's recommendations: Recommendations of the study include using strategies that are customized for each older patient, based on assessment of treatment tolerance and life expectancy. An additional recommendation is women with a life expectancy of greater than five years (regardless of current age) should continue to obtain mammograms.



About the Author
Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator. The author has no financial relationship to any of the companies listed in the article.

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