February 9, 2012
Are Older Breast Cancer Patients Undertreated?
(Ivanhoe Newswire) — It kills wives, daughters, moms, and friends. One out of every 36 women die of breast cancer. Among postmenopausal women with hormone receptor-positive breast cancer, their risk of dying from breast cancer increases with age.
Changing demographics and continuously increasing life expectancy will further enlarge the number of older women confronted with breast cancer. In the United States alone, 41 percent of the women who were diagnosed with breast cancer in 2008 were 65 years old or older.
Willemien van de Water, M.D., of the Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a study to assess disease-specific mortality among age groups in postmenopausal patients with hormone receptor-positive breast cancer. The study consisted of an analysis of 9,766 patients enrolled in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) randomized clinical trial between January 2001 and January 2006. Age at diagnosis was categorized as younger than 65 years (n = 5,349), 65 to 74 years (n = 3,060), and 75 years or older (n = 1,357).
During median (midpoint) follow-up of approximately 5.1 years, there were a total of 1,043 deaths. The number of deaths was 391 (7.3 percent) in patients younger than 65 years, 341 (11.2 percent) in patients ages 65 to 74 years, and 311 (22.9 percent) in patients ages 75 years or older. Cumulative incidence of death due to breast cancer increased from 5.7 percent in patients younger than 65 years, 6.3 percent in patients 65 to 74 years of age, to 8.3 percent in patients 75 years or older.
The researchers also found that mortality from other causes increased with age, and that increasing age was associated with a higher risk of breast cancer relapse.
The authors speculate that a possible underlying mechanism that may help explain the age-specific outcome in this relatively healthy population is that older patients may experience undertreatment, and in particular undertreatment of either chemotherapy or radiotherapy.
These findings “underline the need for age-specific breast cancer studies in order to improve breast cancer outcome in patients of all ages. Moreover, future detailed population-based and translational studies may increase insight into causal factors of higher disease-specific mortality and breast cancer relapse with increasing age," the researchers write.
SOURCE: JAMA, February, 2012