Because the number of older persons is increasing in general, the number of older women with breast cancer is also increasing. It has been previously noted that many older women with breast cancer may have less aggressive disease than younger women with breast cancer. Now, researchers from Colorado and Texas report that, in women 55 years and older, advancing age indeed corresponds with less aggressive disease. In fact, the findings indicate that survival time in older women with breast cancer (without lymph node involvement) is similar to that of age-matched women from the general population, regardless of disease status.

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of the breast. Depending on the

stage of disease (extent of the cancer at diagnosis), treatment options may include surgery, chemotherapy, radiation therapy, and/or hormone therapy. Choices of surgery may include a lumpectomy, a procedure to remove the cancer, or a mastectomy, a procedure to remove the whole breast. After surgery, radiation therapy to the breast area, systemic chemotherapy, and/or hormone therapy with an agent called tamoxifen may be given to prevent recurrence (return) of the disease and to prolong survival time. Older women are at a higher risk than younger women to develop breast cancer; however, younger women comprise the majority of patients enrolled in clinical trials. Because the breast cancer cells may be different in older persons than they are in younger persons, researchers are studying the tumor characteristics and treatment outcomes of older women with breast cancer. Researchers from Colorado and Texas recently evaluated the data from more than 300,000 women with invasive breast cancer to determine the tumor characteristics, treatments received, and survival outcomes of elderly persons with breast cancer.

The researchers obtained information on 50,828 women with invasive breast cancer from the San Antonio breast cancer database and on 256,287 women with invasive breast cancer from the Surveillance, Epidemiology, and End Results (SEER) registry (a government database). They evaluated this patient information to determine tumor characteristics, therapies received, survival according to age, and survival compared with the same-age women from the general population. The results showed that, in women 55 years and older, advancing age was associated with more favorable (less aggressive) tumor characteristics. These favorable characteristics include more cancer cells that have

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steroid (hormone) receptors that could be responsive to hormone therapy; more slow-growing cancer cells; and fewer genetic abnormalities that are associated with poor treatment outcomes. In terms of treatment, the researchers found that elderly patients were less likely to receive systemic chemotherapy or radiation therapy and were more likely to undergo less extensive surgery than younger patients. The use of hormone therapy was equal in older and younger patients. Finally, the survival times of elderly women with breast cancer appeared comparable to those for age-matched women from the general population.

These results have many possible implications for research and treatment of older women with breast cancer. The fact that older women with breast cancer may have more steroid receptor cells may mean that hormone therapy would be especially effective in this group of individuals. Furthermore, because most clinical trials evaluating radiation therapy, chemotherapy, and surgery have been on younger women, the impact of these treatment types on the disease and on quality of life in older women requires study. Finally, the similar survival times between older women with breast cancer (without lymph node involvement) and the general (older) population is a positive finding indeed.

The researchers concluded that these favorable data should be considered by doctors when helping older women with breast cancer to make treatment decisions. Older women who have breast cancer may wish to talk with their doctor about the risks and benefits of the various types of treatments available or of participating in a clinical trial in which promising new therapies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Journal of the National Cancer Institute, Vol 92, No 7, pp 550-556, 2000)

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