Women over age 80 tend to receive less aggressive treatment and experience higher mortality from early-stage breast cancer than their younger counterparts, according to a study published in the Journal of Clinical Oncology.1
Women over the age of 80 are the fastest growing segment of the U.S. population.2 Though breast cancer is relatively common in this group of women, few studies have been conducted to evaluate tumor characteristics and optimal treatment strategies.
Using the Surveillance, Epidemiology and End Results-Medicare database, researchers analyzed the tumor characteristics, treatments, and outcomes of 49,616 women age 67 or older with Stage I or II breast cancer. They then compared the group of women over age 80 with those aged 67-79.
The researchers found that the breast cancer characteristics were similar among the two groups; however, the risk of dying from breast cancer increased significantly with age. Women over age 80 with Stage I breast cancer were more than twice as likely to die from their disease compared with their younger counterparts. Furthermore, they received less aggressive treatment.
Nearly all of the women underwent surgery; however, the researchers found that women over the age of 80 were less likely to receive the standard treatment of breast-conserving surgery plus radiation. Instead, they were more often treated with full mastectomy—most likely in order to prevent the need for radiation, possibly due to older age and perceived intolerance to the therapy. This pattern changed as the women aged, though; the most common treatment in women over age 85 was breast-conserving surgery alone, which led the researchers to conclude that some of the oldest women may be undertreated.
Among women with ER-negative, lymph-node positive breast cancer, chemotherapy has been shown to reduce mortality. In the group of younger women (age 67-79), chemotherapy was associated with a significant reduction in mortality. However, the researchers found that treatment with chemotherapy declined significantly with age.
The researchers concluded that further studies may be warranted to help identify and target treatment to the oldest women who are most likely to benefit.
1 Schonberg MA, Marcantonio ER, Li D, et al. Breast cancer among the oldest old: Tumor characteristics, treatment choices, and survival. Journal of Clinical Oncology [early online publication]. March 22, 2010.
2 Breast Cancer Facts and Figures 2007-2008. http://www.cancer.org/downloads/stt/bcff-final.pdf. Accessed April 2010.