Older breast cancer patients not getting as much care as younger patients

Older women with breast cancer receive less treatment, experience more recurrences and have higher rates of mortality than younger patients. Yet, the incidence of breast cancer increases with age and the proportion of older breast cancer patients in the population is rising, said Dr. Peter Lovrics, professor of surgery at McMaster University. He coauthored a study which compared treatment patterns between younger and older female breast cancer patients. He noted that Canadian guidelines do not currently recommend screening after age 74, but suggested general screening could continue after that. “As our population ages, and there are so many healthy women over 75 years of age, strong consideration should be given to adjusting these guidelines to age 80. There is growing evidence that elderly women are presenting with more advanced cancers and outcomes are worse,” he said At the same time, he said he has observed a lot of variation on how elderly patients are managed. Read: Recent cancer treatment increases risk of COVID-19 adverse outcomes The study compared clinical and pathological disease characteristics, therapies offered and received, and long-term outcomes between younger and older breast cancer patients. The researchers used data from a regional database in South-Central Ontario. The study also examined predictors of breast cancer recurrence and mortality. Results were published in The American Journal of Surgery. The retrospective chart review included all women aged 60 years and up who were diagnosed with invasive breast cancer or ductal carcinoma in situ who underwent surgery from January 2006 to June 2007. Data were used from 12 hospitals in South-Central Ontario. After exclusions, data on 774 women were used, with 515 in the younger group (aged 60 to 75 years) and 259 in the older group (over 75 years). Average follow-up was 10 years. Tumour characteristics were similar between the two groups, but older patients were likely to be more node positive and have larger primary breast tumours at diagnosis. As well, the older patients were more frequently diagnosed with symptomatic disease and had significantly more comorbidities than the younger patients. Results also showed that only 28% of those over 75 had their breast cancer diagnosed by asymptomatic screening compared to 60% of the younger patients. And 67% of the older women had imaging because they were symptomatic, compared to only 38% of those under 75. The study noted that regular screening in average-risk women 75 years or over is not recommended by Canadian breast screening guidelines. “As more older women are identified by symptomatic work-up, this may put them at higher risk of being diagnosed with more advanced or aggressive disease,” the authors wrote. When it came to surgical procedures, again significant differences were seen between the groups. Older patients had significantly fewer breast conserving surgeries 54% of those over 75 compared to 70% of the younger patients), re-excision of positive margins (70% older versus 88% of the younger cohort), axillary lymph node surgery (45% compared to 59%) or sentinel lymph node biopsies (12% older compared to 31% of younger). Older women were less likely to have a consult a medical or radiation oncologist. “It is unclear if this difference is due to potential bias/perceptions of referring surgeons, or patients declining referral,” the study said. Radiotherapy and chemotherapy offered less often For older women who did have an oncology consult, adjuvant radiotherapy and chemotherapy were offered less frequently. However, endocrine therapy was recommended at a similar rate in both age groups. While older women likely get as much benefit from the same treatments as younger women. “The issue is more likely that older women aren’t receiving beneficial treatments as often for multiple reasons,” Dr. Lovrics said. In some cases, older women declined certain interventions but there weren’t enough data to indicate the reasons. In estrogen receptor positive women aged over 75, 39% declined endocrine therapy, and 53% declined adjuvant radiation when they were offered. When it came to surgery, women over 75 years underwent mastectomies more often than the younger group, 46% and 30% respectively. It was also found that the older women were less likely to have re-excision of positive margins after breast cancer surgery and less likely to undergo axillary staging. The reasons for the higher mastectomy rates were unclear and could reflect physician recommendations; patients choosing to avoid radiotherapy, treatment toxicity or having barriers to daily treatment visits; or had larger tumours which required mastectomy. “In our cohort, fewer older patients had a consultation with an oncologist; chemotherapy was offered and received less often for older patients with high risk disease … and post-(breast cancer surgery) radiotherapy was also offered and received less often,” the study said. According to Dr. Lovrics, “It is important that providers not be biased by patients age, and we need to avoid misconceptions that cancer in the elderly ‘is not as bad.’ Elderly patients should be referred to medical and radiation oncologists similar to younger patients. We also need to encourage patients to consider these therapies as they also may have biases or misconceptions about the impact of their age.” Researchers concluded that: “Our study demonstrates that age is an important factor affecting breast cancer diagnosis, treatment and outcomes.” The topic is a relevant as “there are known disparities in breast cancer treatment, access and outcomes in relationship to ethnic background, age, socio-economic status and residence,” said Dr. Shahid Ahmed, professor of medical oncology at the University of Saskatchewan. He was not involved in the study. But disparity in cancer care related to age is not specific to breast cancer, nor to any country or region. “There is evidence of age-related disparity in cancer treatment in various cancers including suboptimal surgery or no surgery for early-stage disease or lack of adjuvant systemic or radiation therapy to reduce the risk of recurrence,” he told the Medical Post. In older women with breast cancer there is a focus on avoiding overtreatment, but that can often result in undertreatment. “I think it is important to not to just focus on chronological age but to take in account the biological age, frailty, and comorbid illness and patient wishes while making shared treatment decision,” he said.

Older breast cancer patients not getting as much care as younger patients

Register for free access or login.

Related Topics