A new study has reported on the methods of breast cancer diagnosis and treatment used for old women. The study included 134 breast cancer patients aged 80 or older for whom data was collected concerning patient and tumor characteristics, treatments received, and outcomes. A total of 146 tumors were diagnosed in the 134 women, of which 65 (45%) were detected by mammogram, implying that more than half of the tumors were detected by the women themselves or their doctors. In younger women, such palpable tumors tend to have worse prognosis (because they typically are not early stage).
Half of the women underwent partial mastectomy (breast conserving surgery that removes substantially more of the breast than lumpectomy) and half underwent mastectomy. While 12 of the women had no axillary staging, 22 underwent axillary lymph node dissection. Of the 73 patients who had partial mastectomies, about half (34) were also treated with radiation (most younger women would have been treated with radiation). The estrogen receptor status was known in 113 of the cancers: 83% were estrogen receptor positive (ER+) and almost all of these women (95%) received anti-estrogen therapy such as an aromatase inhibitor or tamoxifen. Eleven (8%) were HER2/neu overexpressing (HER2+) but only one patient received Herceptin. A total of 14 (10%) of the study population received adjuvant che[motherapy. At follow-up, 87 (65%) patients were alive without evidence of disease, while 6 (4%) had died of breast cancer. The authors conclude that breast cancer in women 80 years and older is more likely to be early-stage with favorable tumor biology. While most women eligible for anti-estrogen therapy received it, adjuvant radiation, chemotherapy, and Herceptin were used infrequently. Despite these differences in care compared to younger women, older women with breast cancer are unlikely to suffer breast cancer-related death.
Comments regarding the study
Decisions concerning the extent of treatment for an old women diagnosed with breast cancer should be made before breast cancer surgery, if possible. While the low rate of lumpectomy makes sense in this population, since the more extensive surgery represented by partial mastectomy will protect women from local recurrence who are not expected to undergo radiotherapy, the high rate of axillary node dissection does not. The primary purpose of axillary node dissection is to stage breast cancer, not to treat it. If a decision already has been made not to treat with chemotherapy, there may not be a need to perform sentinel node biopsy or axillary node dissection, which increases postoperative pain and the risk of debilitating lymphedema.
Having said this, treatment decisions should be made on an individual basis, taking into account the overall health of the woman. Indolent, less aggressive tumors still kill in the long run and the death is not easy. The healthier the woman, the more she might have to gain from adjuvant treatment.