According to the results of a study conducted within six large managed care organizations, breast cancer patients over the age of 75 are less likely than younger patients to receive standard, effective breast cancer treatments. These results were published in the Journal of Clinical Oncology.
A substantial body of evidence shows that breast cancer treatment varies by age, with older women being less likely to receive standard care. Reasons for this variability are uncertain, but may include lack of clinical trial data for older women; concerns about the risks of treatment in older women; and differences in access to care.
To build upon earlier studies, researchers conducted a study within six large managed care organizations-Group Health Cooperative, Western Washington; Kaiser Permanente, Southern California; Lovelace, New Mexico; Henry Ford Health System, Michigan; HealthPartners, Minnesota; and Fallon Community Health Plan, Massachusetts.
The study included 1,859 women age 65 or older who had been diagnosed with Stage I or Stage II breast cancer at one of the participating health plans.
Standard primary therapy was defined as either breast conserving surgery with axillary lymph node dissection followed by radiation therapy or modified radical mastectomy.
- Compared to women between the ages of 65 and 69, women between the ages of 75 and 79 were three times more likely to receive non-standard primary therapy, and women age 80 or older were almost six times more likely to receive non-standard primary therapy. Older women were less likely to undergo axillary lymph node dissection, and were also less likely to receive radiation therapy after breast conserving surgery. These age-related differences in treatment were not explained by differences in risk of recurrence or the presence of other chronic health problems.
- Older women were also less likely to receive chemotherapy than younger women, but the researchers note that this was consistent with treatment guidelines at the time of study enrollment (the early- to mid-1990s).
- There was no difference by age in use of tamoxifen.
This study provides additional evidence that older women with breast cancer are less likely than younger women to receive standard breast cancer treatments, even after accounting for risk of recurrence and the presence of other chronic health problems. The researchers note that tools to help older patients and their physicians weigh the risks and benefits of treatment are needed.
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 Mandelblatt J. Treating Breast Cancer: The Age Old Dilemma of Old Age. Journal of Clinical Oncology. 2006;24:4369-4370.
 Enger SM, Thwin SS, Buist DSM et al. Breast Cancer Treatment of Older Women in Integrated Health Care Settings. Journal of Clinical Oncology. 2006;24:4377-4383.
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