Breast cancer treatment and ageWomen 75 or older with early-stage breast cancer are more likely to receive nonstandard primary tumor therapy in an integrated health care setting, reported a study in the Sept. 20, 2006, Journal of Clinical Oncology.
Dr. Rebecca Silliman of Boston University Medical Center and colleagues identified 1,859 women 65 years of age or older with stage I or II breast cancer between 1990 and 1994 from six geographically diverse integrated health systems of the Health Maintenance Organization Cancer Research Network.
Using SEER cancer registries, as well as clinical and administrative databases, researchers collected data on demographics, tumor characteristics, breast cancer treatment, and comorbid conditions prior to diagnosis.
Researchers then compared women who received standard primary tumor therapy, defined as axillary lymph node dissection and radiation therapy after breast-conserving surgery (BCS), with women who received nonstandard primary tumor therapy. They also compared women who received a tamoxifen prescription or chemotherapy with women who did not.
Women with higher comorbidity index scores, and women 75 or older, were more likely to receive nonstandard primary tumor therapy. While risk of recurrence was also associated with receipt of nonstandard primary tumor therapy, no link exists for standard primary tumor therapy. Additionally, researchers found that African American women were less likely to be prescribed tamoxifen and Asian women were more likely to undergo BCS than were white women.
The study's authors concluded that "Age is an independent risk factor for nonreceipt of effective therapies, even when comorbidity and risk of recurrence are considered."
An accompanying editorial by Dr. Jeanne Mandelblatt of the Lombardi Comprehensive Cancer Center in Washington, D.C., noted that, "What we need is an understanding of the biology of cancer in this population [women 65 or older with breast cancer], tools that can help clinicians identify physiological reserve and ability to withstand the rigors of more aggressive treatment, and more consistent elicitation of women's informed preferences."
Information provided by the National Cancer Institute, www.cancer.gov
