Compared to younger women, older women with breast cancer are less likely to be diagnosed via needle biopsy and triple assessment, less likely to undergo surgery and less likely to receive radiotherapy, researchers report in the British Journal of Cancer. Such management of older women is likely to lead to higher rates of local recurrence of the disease and higher than necessary mortality.

Dr. Katrina Lavelle, who led the study at the University of Manchester’s School of Nursing, Midwifery and Social Work, explains: "We have found that older women from aged 70 and over are less likely to receive the same breast cancer care as younger women and that this is related to their age rather than differences in the biology of their tumor."

The highest incidence of breast cancer in England occurs in women aged 70 years and older. Older women also experience the worst survival; women aged 70-79 have a 76% five-year relative survival compared to 80% for all ages, and for women aged 80 plus this drops considerably to 61%, beyond what might be expected owing to an increase in age.

The team carried out a retrospective cohort study involving case note review based on the North Western Cancer Registry database of women aged 65 and over, resident in Greater Manchester with invasive breast cancer registered over a one-year period.

The they found that, compared to women aged 65-69 years, women aged 80 plus with operable breast cancer have increased odds of not receiving triple assessment, not receiving primary surgery, not undergoing axillary node surgery and not undergoing steroid receptor tests (which indicate suitability for hormone therapy). Compared with her 65-69-year-old counterpart, the odds of a woman aged 80 or older not receiving triple assessment for operable breast cancer are five-and-a-half times higher, and the odds of her not receiving surgery are more than 40 times higher. Even women as young as 70-74 have over 7 times the odds of not receiving radiotherapy following breast conservation surgery compared to women aged 65-69 years.

In addition, the team discovered that the overall percentage of women in all the age groups not receiving steroid receptor tests was high at 41%, which resulted in treatment decisions being taken without this fundamental information. Three quarters of the patients who did not receive steroid receptor tests were given the hormone therapy, tamoxifen; that is, prescribed a treatment without evidence that it would work. In a survey of UK breast cancer surgeons in 2004, 75% reported that they would treat older breast cancer patients in a similar way to younger patients and 98% responded that the cut off point for breast cancer surgery was not age related.

Dr. Lavelle says: "Clearly there is a difference in clinicians' perceptions of how older breast cancer patients should be treated and their actual practice…. Mortality of elderly breast cancer patients is unlikely to improve where this pattern of management persists."

SOURCES:
British Journal of Cancer, March 26, 2007
University of Manchester (http://www.manchester.ac.uk)