CHICAGOThere is no clear consensus among oncologists about the
degree to which elderly breast cancer patients should be subjected to
aggressive diagnostic and therapeutic strategies. Physicians
consequently have tended to treat elderly women with invasive breast
cancer conservatively because of the view that comorbid conditions
and advanced age make them more likely to die of causes other than
Data from a study presented at the 85th Annual Meeting of the
Radiological Society of North America (RSNA) suggest, however, that
elderly women with invasive breast cancer should be offered standard
therapy because they die more often of breast cancer than other
diseases, said Brian Lawenda, MD, of the Naval Medical Center, San Diego.
The study retrospectively analyzed patient records and tumor registry
data from the Naval Medical Center and Tripler Army Medical Center,
Honolulu, to identify women aged 75 and older who had been diagnosed
with breast cancer between 1988 and 1998.
A total of 71 breast cancer lesions had been detected during that
period of time in 68 women who ranged in age from 75 to 90 years.
About half (49%) of the lesions were initially diagnosed on
mammography, and the remaining 51% were found during clinical breast
examination. Half of the women underwent mastectomy, 44% had
breast-conserving surgery, and 9% had fine-needle aspiration as their
only therapeutic intervention.
Among the women who had breast-conserving surgery, only 64% received
local radiotherapy. In contrast, overall, more than 80% of US women
who have lumpectomy receive radiotherapy.
Although 80% of patients had tumors that were estrogen-receptor
positive, only a little over half (51%) of these women received
hormonal therapy. Only 29% of women with lymph node involvement
received chemotherapy or radiotherapy. Chemotherapy was given to 10%
of women with positive lymph nodes; the majority of women with nodal
involvement (80%) received hormonal treatment.
The study defined nonstandard treatment as breast-conserving surgery
without radiotherapy or treatment with fine-needle aspiration alone,
and standard therapy as mastectomy alone or breast-conserving surgery
in combination with radiotherapy.
With a median follow-up of 37 months, the difference in overall
survival between women treated with standard therapy (69%) vs those
given nonstandard therapy (44%) is not significant although it
is clinically impressive, Dr. Lawenda said. Breast cancer was
the principal cause of death for most patients in the study. Although
82% of the patients had a comorbid condition, 58% (14 of 24 patients)
died of their underlying breast cancer.
Citing a recent study from the Institute of Medicine, Peter A.
Johnstone, MD, head of the radiation oncology division at the Naval
Medical Center, said that in many cases, elderly people are
less likely to get effective cancer therapy than younger people
despite evidence they can tolerate it and benefit from it. The
underuse of aggressive therapy among older people is often assumed to
be related to the presence of coexisting conditions, but even among
those without complicating conditions, there are treatment
differences according to age.
Although physicians may feel that older women are too frail to have
aggressive treatment for breast cancer, thats not always
the case, Dr. Johnstone said. These data show that we
need to be more aggressive with therapy in older patients. People are
living longer and better, and age and coexisting medical problems
seem less important than we previously considered.