Treatment of breast cancer among older women – adapted from J Am Geriatr Soc 1996;44;390-3 – Tips from Other Journals
Although an estimated 40 percent of all breast cancer patients are 70 years of age or older, treatment has generally been less aggressive in older women than in younger women. It has been widely believed that older women have more locally advanced disease at initial presentation, have less aggressive breast cancer, have a limited life expectancy and will not tolerate standard surgical and systemic treatment. However, as life expectancy among women continues to increase and the risk of breast cancer increases with age, it is important to examine the impact of age as a prognostic factor. Masetti and colleagues conducted a retrospective study to investigate the role of surgery and the impact of age in older women with breast cancer.
A total of 190 women 70 years of age or older who were treated by surgery for breast cancer from 1967 to 1991 were reviewed retrospectively and matched with 190 younger patients treated in the same period. Surgical treatment of both groups included radical mastectomy (14.2 percent), modified radical mastectomy (64.2 percent), simple mastectomy (17.4 percent), and quadrantectomy with complete axillary dissection (4.2 percent). Postsurgical radiation therapy was administered in 54 percent of patients.
Patients were evaluated at three-month intervals during the first year and every six months thereafter. Mean follow-up time was 63 months. Among the older women, 60 patients (31.5 percent) had a recurrence of breast cancer, with a mean time between treatment and recurrence of 31 months. Among the younger women, 77 patients (40.5 percent) had a relapse after a mean time of 39 months. Neither group had operative mortalities. The 10-year actuarial breast cancer-specific survival rates and the disease-free survival rates of older women were 66 percent and 54 percent, respectively. In the younger women, the rates were 56 percent and 45 percent, respectively. Results of univariate and multivariate analyses indicated that the significant prognostic factors for both younger and older women were tumor size and nodal stage.
The authors conclude that women over 70 years of age with breast cancer have outcomes similar to that of younger women with breast cancer and should receive similar treatments. Appropriate surgery should have the major role in the treatment of breast cancer patients regardless of age. Appropriate surgery allows the best chance for definitive cure with the lowest risk of local recurrence. (Masetti R, et al. Breast cancer in women 70 years of age or older. J Am Geriatr Soc 1996;44:390-3.)
COPYRIGHT 1996 American Academy of Family Physicians
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