AGE-RELATED PATTERNS OF CARE - EVIDENCE AGAINST AGEISM IN THE TREATMENT OF EARLY-STAGE BREAST-CANCER

Purpose: To assess whether the use of adjuvant systemic therapy in pos tmenopausal women with early-stage breast cancer is influenced by pati ent age. Methods: A retrospective cohort study based on data collected from medical records and from patients and their surgeons was perform ed among 746 postmenopausal patients diagnosed with early-stage breast cancer at 30 hospitals located throughout Minnesota, The adjusted odd s of receiving hormonal therapy, chemotherapy, and both hormonal thera py and chemotherapy as a function of age was determined. Results: Amon g women with negative lymph nodes, 62% received some form of adjuvant drug therapy. For these women, the likelihood of receiving hormonal th erapy or both hormonal therapy and chemotherapy did not vary with pati ent age and the likelihood of receiving chemotherapy declined with age , Among women with positive lymph nodes, 92% received some form of adi uvant therapy, For these women, the likelihood of receiving hormonal t herapy increased with age and the likelihood of receiving chemotherapy declined with age, as did the likelihood of receiving both hormonal t herapy and chemotherapy. Conclusion: The observed associations between age and the use of adjuvant systemic therapy appear to reflect, in ge neral, available information about treatment efficacy and do not sugge st underuse among elderly women with early-stage breast cancer. The us e of adjuvant therapy depends on clinical factors that predict the inc reased risk of metastases or the increased likelihood of response to t reatment, rather than other sociodemographic factors, Our results also suggest that younger postmenopausal women with positive lymph nodes c ompared with older women may be undertreated with respect to tamoxifen because of the substitution of chemotherapy for hormonal therapy. (C) 1997 by American Society of Clinical Oncology.