Breast cancer is the commonest cancer in women and is the second-leading cause of death from cancer (lung cancer is the first). Two-thirds of new cases are in women beyond the menopause (i.e. over 55), and in these, it's most common around the ages 75 to 80. Of course, at this age, many women have other diseases that affect how they can stand up to some of the treatment options for breast cancer. A new study done by the U.S. National Institutes of Health (NIH) has examined this more closely.

National tumor registries were used to gather information on breast cancer cases in women over 55 years of age. Follow-up information was obtained for 30 months after the diagnosis. The 'stage' of the tumor, the treatment given, and the presence of other conditions were determined, and the information analyzed according to different age groups.

Altogether, there were 1,800 patients aged 55 to 101. 93% of them were white, 5% were black and 2% were other races. Three-quarters of them had Stage 1 or Stage II breast cancer. (In Stage I: the tumor is small - less than 2 cm [3/4 inch] across - and cancer cells have not spread beyond the breast. In Stage II: either the tumor is less than 2 cm across, but the cancer has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm with or without spreading to the lymph nodes; or the tumor is larger than 5 cm but has not spread to the lymph nodes.)

In 300 of the women (17%) it was not possible to 'stage' the tumor. This was because there wasn't enough information on all the features of the tumor (e.g. lymph node spread). Not surprisingly, lack of staging was more frequent in the older age groups, presumably because these women were frailer, or had other diseases that interfered with a complete examination.

95% of women with stage I and II in this set of over 55 year-olds were treated according to NIH recommendations published in 1990 (i.e. partial breast removal with following radiation, or modified total breast removal). The older age groups (the over 70s) were less likely to be given the recommended treatment. For instance, those who had a partial mastectomy were less likely to get follow-up radiation than those in the younger age groups (55-70). Also, they were less likely to have the axillary lymph nodes explored and removed. Again, all this is presumably because they were frailer and had more existing medical conditions.

Illnesses were found more frequently in the older age groups. The commonest was high blood pressure, followed by arthritis. There were several severe illnesses that were found to have a harmful effect on survival. Breast cancer women who had diabetes, kidney failure, stroke, liver disease, a previous cancer, or who smoked, were all likely to die earlier than those who hadn't got such conditions.

263 of the whole group died during the 30-month follow-up period - 15% altogether. Over half of these were due to the breast cancer itself. However, in the older age groups (70 years and above), heart and blood vessel disease were increasingly common causes of death.

What is the significance of this study? The good news is that 95% of the women were given the most appropriate treatment. However, things were less satisfactory in as the women were older. The fact that death was hastened in women with accompanying diseases suggests that the 15% mortality within the first 30 months might be reduced further by energetic treatment of these diseases. In this way, we can hope that the outlook for elderly breast cancer patients will improve still more.

Source

Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older
R. Yancik, MN. Wesley, LAG. Ries, JAMA, 2001, vol. 285, pp. 885--892

Links

• Should I have a Pap smear every year?
• Disease Digests: Breast Cancer
• What is your cancer risk?