The effect of under-treatment of breast cancer in women 80 years of age and older
Section snippets
Background
The average life expectancy in the United States has been rising nearly continuously since 1900. In 2005, the mean life expectancy of a woman at birth was 80 years [1]. This aging of the population is projected to continue; in the next 25 years the number of American women over the age of 65 years is expected to increase 104% and the number of women 85 years and older is also projected to double [2], [3].
As with most cancers, the risk of developing breast cancer increases with age from 1 in 209
Methods
After obtaining Institutional Review Board approval a retrospective analysis was performed on data collected from the medical records of newly diagnosed breast cancer patients 80 years and older evaluated at the MD Anderson Cancer Center between September 1, 1989 and September 1, 2004. Any patient who received breast cancer counseling (and ultimately refused care) or any component of multi-modality breast cancer treatment in our institution was included. Patients presenting with a recurrent
Results
Two hundred twelve patients were identified from our institutional database, patient demographics and treatment are described in Table 1. The median age was 83.5 years (range 80–97). Overall survival in the entire cohort was 7.28 years with a median follow up of 4 years for patients still alive at the end of the study period. Ninety-two (48.4%) patients were diagnosed with stage 1 disease, ten patients presented with stage IV disease. Forty three percent of patients received all treatment
Discussion
This study shows that the majority of very elderly women are still offered less than standard and unimodality instead of multi-modality treatment, resulting in unnecessary local regional recurrence as well as an increased possibility of risk of disease related death.
Several factors have been named in the literature as a basis for substandard treatment: older patients have a higher prevalence of comorbidities and lower life expectancy compared to younger patients [11], treatment may be perceived
Conflict of interest
None declared.
Reviewer
Professor Riccardo Audisio, Consultant Surgeon; Surgical Oncologist, Whiston Hospital, Department of Surgery, Warrington Road, Prescot, Merseyside L35 5DR, United Kingdom.
B.L. Van Leeuwen, M.D., Ph.D. is a surgeon with the elderly patient as main interest. She was employed by the Dutch Cancer Foundation 2007–2009 as a clinical and research fellow in “cancer in the elderly”. As such she gained valuable working and research experience in Uppsala University Hospital, Sweden, Whiston Hospital in Liverpool and the MD Anderson Cancer Center in Houston, USA. Since 2007 she has been the primary investigator of a project financed by the Dutch Government (ZonMw) entitled;
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B.L. Van Leeuwen, M.D., Ph.D. is a surgeon with the elderly patient as main interest. She was employed by the Dutch Cancer Foundation 2007–2009 as a clinical and research fellow in “cancer in the elderly”. As such she gained valuable working and research experience in Uppsala University Hospital, Sweden, Whiston Hospital in Liverpool and the MD Anderson Cancer Center in Houston, USA. Since 2007 she has been the primary investigator of a project financed by the Dutch Government (ZonMw) entitled; “A controlled trial of geriatric liaison intervention in frail surgical oncology patients.” She started work in the University Medical Center Groningen in September 2008 and was rewarded a tenure track fellowship by the University. She is a member of the research taskforce of Gerionne (Geriatric Oncology in the Netherlands) and the surgical taskforce of the International Society of Geriatric Oncology (SIOG). Together with Professor R.A. Audisio (University of Liverpool) she is co-investigator of an international study investigating the predictive value of several preoperative screening instruments in frail elderly patients.
- 1
Tel.: +1 603 650 9479; fax: +1 603 650 8030.
- 2
Tel.: +1 713 7451563; fax: +1 713 4044572.
- 3
The Department of Surgical Oncology, MD Anderson Cancer Center includes Feig B, Ames F, Hwang R, Lucci A and Meric-Bernstam F.