Gee whiz...imagine that

[Tom]

Diagnosis and treatment of breast cancer suboptimal in elderly patients

Reuters Health
Posting Date: October 16, 2006

Last Updated: 2006-10-16 16:00:17 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Breast cancer diagnosis is delayed in elderly patients, due in large part to underuse of mammography, and such patients are not treated as aggressively as their younger counterparts, findings from a new study show.

The results, appearing in the October issue of the Archives of Surgery, confirm the findings of previous reports. However, in contrast to prior studies, the current research took place in a community hospital setting, where, as the investigators point out, the majority of cancer patients are treated.

Searching a tumor registry maintained at a community hospital, Dr. David A. Litvak and Dr. Rajeev Arora, from Michigan State University in Lansing, identified 354 patients who were diagnosed with breast cancer between 1992 and 2002 and were at least 70 years of age.

Forty-six percent of subjects presented with a palpable breast tumor. Seventy-two percent of all women received a mammogram, but in only 54% of cases was the mammogram used to detect an occult malignancy, rather than to simply confirm physical examination findings. In patients 80 years of age and older, the percentage of mammograms used for true screening was even lower -- 38%.

Over 70% of patients were diagnosed as having stage I or II disease, yet just 64% of patients received complete pathologic staging for their malignancy.

Roughly 50% of women underwent breast-conserving surgery, but the percentage that received adjuvant chemotherapy was 45%, much lower than would be expected in younger patients, the researchers note. Similarly, chemotherapy was given to just 29% of patients with node-positive disease and adjuvant hormone therapy was applied to 67% of women with ER-positive tumors.

There is evidence to suggest that the undertreatment identified in this study and others does, in fact, lead to worse outcomes, the researchers state. Breast cancer patients should not be denied a particular therapy based solely on their age, they add. "Contrary to many physicians' beliefs, the data suggest that fit older patients derive the same benefits from treatment as do their younger counterparts."

Arch Surg 2006;141:985-990.