CANCER OF THE OLDEST-OLD - WHAT WE HAVE LEARNED FROM AUTOPSY STUDIES

Cancer in the oldest old is a novel problem, due to the recent burgeon ing of the population aged 85 and older. This article addresses three critical questions related to cancer in the eldest old: Does the incid ence of cancer increase after age 95? Is cancer a common cause of deat h for the oldest old? Is cancer accurately diagnosed in the oldest old ? The authors analyzed a group of 507 autopsies of elderly divided in three age groups, 75-90 years, 95-99, and over 99 (centenarians). The prevalence of cancer was 35% among the younger persons and 20% and 16% respectively for those aged 95-99 and for the centenarians. A fourth of the patients in the younger group died from cancer but only 9.5% of The people between 95 and 98 years and 7.1% of the centenarians died from cancer. The cancer was the direct cause of death for 67% of the y ounger persons and 41% of patients belonging to the two oldest groups. The prevalence of metastases was 63% for tumors occurring in persons aged 75-90, 32% in persons aged 95-98, and 29% in the centenarians. Ca ncer had been accurately diagnosed prior to death in 67.4% of persons aged 75-90, in 38.5% of those aged 95-99, and 29.4% of the centenarian . Cancer as cause of death had been underestimated in 16% of the cases in the younger persons and in almost 50% of cases of the oldest old. This study suggests that the incidence of cancer and the importance of cancer as a cause of death map decline after age 95 and that the clin ical diagnoses underestimate significantly both the incidence of cance r and the prevalence of cancer deaths in the oldest old.