Compliance with consensus recommendations for the treatment of early stagebreast carcinoma in elderly women

BACKGROUND. The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care receiv ed. METHODS. A stratified random sample was selected among women age greater th an or equal to 50 newly diagnosed with lymph node negative breast carcinoma in Quebec in 1988, 1991, and 1993. Information was abstracted from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast-conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple lo gistic regression analysis. RESULTS. Overall, 1174 patients age greater than or equal to 50 Fears with breast carcinoma were included. Women age greater than or equal to 70 years were much less likely to receive definitive locoregional treatment compare d with women ages 50-69 years (48.7% vs. 83.5%; P < 0.0001). Older women we re less likely to undergo surgery with breast preservation (76.7% vs. 86.3% ; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 6 4.7%; P = 0.41). adjusting for comorbidity and other characteristics relate d to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12-0 .18 for women age greater than or equal to 70 years vs. women ages 50-69 ye ars). The same association was observed when women who did not undergo lymp h node dissection but who received systemic adjuvant treatment were conside red to have received definitive therapy (OR, 0.13; 95% CI, 0.10-0.17) for w omen age greater than or equal to 70 years vs, women ages 50-69 years). CONCLUSIONS. Less aggressive patterns of care are provided to elderly breas t carcinoma patients. independent of comorbidity. This could explain, at le ast in part, the sustained breast carcinoma mortality in this population. C ancer 1999;85:1104-13. (C) 1999 American Cancer Society.