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Age and Breast Cancer Treatment: A Matter of Life and Death
By Nancy Plese
Age shouldn’t matter when it comes to breast cancer treatment. But study after study has shown that women older than age 65—almost half of the breast cancer population—get less aggressive treatment than younger women.
“Undertreatment of breast cancer is associated with increased mortality,” conclude Marianne Ulcickas-Yood, D.SC., M.P.H., and colleagues in the Journal of the American College of Surgeons (January 2008). Their study followed 1,837 older women for 10 years after they were treated for stage I or II breast cancer diagnosed between 1990 and 1994.
When older breast cancer patients receive less-than-standard therapy, they often don’t live as long as better-treated patients. Those treated with lumpectomy alone in this study were twice as likely to die as those treated with mastectomy or lumpectomy plus radiation therapy.
Rural or urban, rich or poor, white or black, all older women are at risk of undertreatment in all types of practice settings, Ulcickas-Yood’s report observes. Older women might be losing many good years of life due to undertreatment, now that many women live well into their 90s. In fact, a 75-year-old woman has an average future life expectancy of 12 years. Only after age 95 is average future life expectancy less than 5 years. More aggressive treatment has been shown to give women more years of life, no matter how old they are.
Older women are not even being studied as much as younger women. Ulcickas-Yood says, “Increasing the participation of older breast cancer patients in clinical trials should help in the development of breast cancer treatment guidelines for older women.”
What is it about older women? Ulcickas-Yood says that there are a number of factors—including physician and patient attitudes and beliefs. The study looked at a number of factors, but none of them—including whether or not the women were sick with other diseases—explained undertreatment. The message for patients is: demand to know all your treatment options for your breast cancer, as well as their risks and benefits, no matter how old you are.
