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Women over age 80 with early stage breast cancer frequently do not get a full range of treatments, even after considering their health and treatment preferences, according to a new study funded by the Agency for Healthcare Research and Quality (HS08395). The study was conducted by researchers at Georgetown University's Lombardi Cancer Center in Washington and their colleagues at 29 hospitals across the country. The researchers studied 718 breast cancer patients age 67 years and older who were diagnosed with localized disease between 1995 and 1997.
Specifically, women 80 years and older were less likely to be referred to a radiation oncologist, and after breast conserving therapy, they were more than three times as likely not to receive radiation therapy. The risk of cancer recurrence approaches 40 percent within 10 years when radiation is not given after a lumpectomy, well within the life expectancy for most older women.
The study also found that older black women seem to be less likely than white women in the same age group to receive radiation after lumpectomy. Researchers note that while the sample of black women was fairly small, this finding of differences in breast cancer treatment patterns by race is consistent with other research. The researchers point out that older women's preferences, such as maintaining body image, were consistently important in determining treatment. They also note that when patient-physician communication focuses on patient concerns, it helps overall in patient selection of therapies and satisfaction with treatment.
This is one of the first large studies of breast cancer treatment to focus on older women that includes a defined stage of the disease and detailed information about patient, clinical, physician, and other factors affecting treatment patterns. Older women, particularly those 80 years of age and older, are the fastest growing segment of the U.S. population and will account for an increasing absolute number of breast carcinoma cases in the coming decades. Thus, additional research is urgently needed to determine the appropriate clinical approach to treating breast cancer in older women and to include this underrepresented population in future clinical trials.
Details are in "Patterns of breast carcinoma treatment in older women: Patient preference and clinical and physician influences" by Jeanne S. Mandelblatt, M.D., M.P.H., Jack Hadley, Ph.D., Jon F. Kerner, Ph.D., and others, in the August 2000 issue of Cancer 89, pp. 561-573.
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