AGE-RELATED DIFFERENCES IN BREAST-CANCER-TREATMENT

Background: More than half of the cases of breast cancer treated in th e United States occur in women over age 65. This study investigates ag e-related differences in breast cancer therapy. Methods: A retrospecti ve review of all women with primary operable invasive breast cancer tr eated at the University of Michigan Breast Care Center over a 30-month period showed a total of 77 older patients aged greater-than-or-equal -to 65 years (median, 71; oldest patient, 92) for whom full informatio n was available regarding comorbidity, tumor stage and histology, and details of surgery, radiation, and chemohormonal therapy and complicat ions. Fifty-one similar younger patients aged 55-64 years (median, 59) were identified for comparison. Patients were classified as either ha ving received standard treatment or nonstandard treatment. Standard th erapy was prospectively defined as follows: local/regional-lumpectomy and axillary lymph node dissection plus radiation therapy or modified radical mastectomy; systemic-chemotherapy and/or tamoxifen for stage I I disease. A comorbidity score calculated for each patient assigned on e point each for nursing home residence, nonambulatory status, recent surgery, and each medical problem requiring drug therapy. Results: Whe n overall treatment (local/regional plus systemic) was assessed, propo rtionately fewer older patients (55 of 77 versus 47 of 51; p < 0.01) r eceived standard treatment. Fewer older than younger patients (62 of 7 7 versus 50 of 51; p < 0.01) received surgical therapy that included a n axillary dissection. A smaller proportion of older patients received radiation therapy following lumpectomy and axillary lymph node dissec tion (26 of 29 versus 19 of 19; N.S.). Overall, only 59 of 77 older pa tients versus 50 of 51 younger patients (p < 0.001) received standard local/regional care. Similar proportion of younger and older patients (19 of 22 and 24 of 30, respectively) received standard systemic thera py for stage II breast cancer, but older patients were less likely to receive chemotherapy than younger patients (7% versus 50%; p < 0.001). Treatment-related complications were not age-related but were more fr equent in patients receiving standard treatment than in patients recei ving nonstandard treatment (45 of 102 versus two of 26; p < 0.001). Co morbidity score correlated with the use of nonstandard therapy but not with age. The scores for both older and younger patients receiving ov erall standard treatment were 0.8 versus 1.5 and 1.4, respectively, in patients receiving nonstandard treatment. Interestingly, explanations for decisions to deviate from standard treatment guidelines were ofte n not identified. Comorbidity was explicitly noted in only one of four younger patients who received nonstandard treatment therapy. In 22 ol der patients who received nonstandard treatment, comorbidity was cited in eight cases, patient age was cited in six cases, and patient choic e was cited in four cases. Follow-up (median, 34 months) did not show that disease-free or overall survival differences were related to age or to treatment (standard versus nonstandard).