Breast cancer undertreated in elderly patients
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Breast cancer diagnosis is delayed in elderly patients, due in large part to the underuse of mammography, and these patients are also not treated as aggressively as their younger counterparts, findings from a new study show.
The results, appearing in the Archives of Surgery, confirm the findings of previous reports. However, in contrast to prior studies, the current research took place in a community hospital setting, where, as the investigators point out, the majority of cancer patients are treated.
Searching a tumor database maintained at a community hospital, Dr. David A. Litvak and Dr. Rajeev Arora, from Michigan State University in Lansing, identified 354 patients who were diagnosed with breast cancer between 1992 and 2002 and were at least 70 years of age.
Forty-six percent of subjects were diagnosed with a breast tumor apparent on physical examination. Seventy-two percent of all women underwent a mammogram, but in only 54 percent of cases was the mammogram used to detect a cancer that was not readily identified on physical examination. In patients 80 years of age or older, the percentage of mammograms used for true screening was even lower - 38 percent.
Over 70 percent of patients were diagnosed with breast cancer in a relatively early stage, yet just 64 percent of patients underwent a complete evaluation for their cancer.
Roughly 50 percent of women underwent breast-conserving surgery, but the percentage that also received recommended chemotherapy was 45 percent, much lower than would be expected among younger patients, the researchers note. Similarly, hormone therapy, such as tamoxifen, was given to just 67 percent of women who might have benefitted from this treatment.
There is evidence to suggest that the undertreatment identified in this study and others does, in fact, lead to worse patient outcomes, the researchers state. Breast cancer patients should not be denied a particular therapy based solely on their age, they add. “Contrary to many physicians’ beliefs, the data suggest that fit older patients derive the same benefits from treatment as do their younger counterparts.”
SOURCE: Archives of Surgery, October 2006.
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