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Health Care for Women and Children

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Breast cancer treatment in older women often depends on the woman's age and treatment preferences

Nearly half of new breast cancer cases and nearly two-thirds of deaths from this disease occur among women 65 years of age or older. Breast conservation surgery and radiation therapy are often recommended for treating localized breast cancer, but a woman's age and her treatment preferences strongly influence the type of treatment an older woman will receive for this type of cancer.

A recent study supported by the Agency for Healthcare Research and Quality (HS08395) found that women who were concerned about body image were nearly twice as likely to receive breast conservation surgery and radiotherapy as women without this concern. In contrast, women who preferred to have no therapy beyond surgery were nearly four times as likely to undergo mastectomy as other women.

Compared with women 67 to 79 years of age, women 80 years and older were 3.4 times as likely to have radiotherapy omitted after breast conservation surgery (increasing their risk of local recurrence) and 70 percent less likely to receive chemotherapy. The older women also were less likely to have been referred to a radiation oncologist (28 percent) than the younger women (44 percent). Women with estrogen receptor positive tumors were 4.3 times more likely to receive tamoxifen (an anti-estrogen) than women with estrogen receptor negative tumors. However, women aged 80 and older received tamoxifen almost twice as often as women 67-79 years of age, after accounting for health, clinical, and other factors.

These findings show that many of the women 80 years of age and older were undertreated by current standards and lend support to potential age biases in breast cancer treatment, concludes Jeanne Mandelblatt, M.D., M.A., of Georgetown University School of Medicine. Dr. Mandelblatt and her colleagues analyzed data that tracked treatment of women 67 years of age or older with primary early-stage invasive breast cancer for which breast conservation and mastectomy were considered "equivalent choices." The subjects were drawn from a sample of 29 hospitals in five regions.

See "Patterns of breast carcinoma treatment in older women: Patient preference and clinical and physician influences," by Dr. Mandelblatt, Jack Hadley, Ph.D., Jon F. Kerner, Ph.D., and others, in the August 1, 2000 Cancer 89(3), pp. 561-573.

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