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Patterns of Breast Carcinoma Treatment in Older Women

Jeanne S. Mandelblatt, Jack Hadley, Jon F. Kerner, et al.
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

Reviewers: Li Liu, MD
Source: Cancer, Volume 89:561-573, (August) 2000

Précis: Very elderly women in US were often not offered full range of breast cancer treatments.

Introduction

The choices of treatment for breast cancer are influenced by many factors, some of which have a sound scientific basis, others of which are based on highly personal opinions of physicians and on the type of hospital in which medical practice is conducted. The rising prevalence of coexisting diseases with age and certain physiologic changes in the elderly, which may reduce the capacity to tolerate complications of the therapy, are possible reasons for physicians to treat elderly breast cancer patients differently from younger patients. This study examined the effect of age on choice of first-line treatment in elderly breast cancer patients.

Method

A total of 718 women, 67 years of age or older, who were newly diagnosed with localized breast cancer were included.

Results

  • Women aged 80 or older were significantly less likely than women 67 to 79 years old to be referred to a radiation oncologist.
  • After breast-conservation therapy, very elderly women were 70% less likely to receive chemotherapy than the younger subjects, and they were 3.4 times less likely to receive radiation therapy.

Discussion

In this study, among elderly women with early-stage breast cancer, age had a strong influence on treatment patterns, and many very elderly women were vulnerable to receiving less treatment than currently recommended in expert consensus guidelines. These results underscore the importance of incorporating patients' preferences in treatment decisions. Assessment of quality health care should take into account the interactions between the physician and patient in deciding which treatment to pursue.