Breast Cancer and The Elderly

 

Breast Cancer and The ElderlyYes, breast cancer is a treatable disease. Although this relieves a lot of men and women out there, one’s age can make a difference. There are a few questions being raised regarding this. Is breast cancer treatment different for seniors? Are the risk factors greater if you are much older?

Breast Cancer and Seniors

When detected early, breast cancer is treated successfully 98% of the time. Researchers continue to make impressive gains in the detection, diagnosis, and treatment of breast cancer. For example, according to the Mayo Clinic, the radical mastectomy, once a standard procedure for women with breast cancer, is now rarely performed.

However, breast cancer in seniors remains a very potent disease that will only be eradicated if women follow the recommended schedule and undergo annual mammograms. Recent statistics suggest that women are skipping annual mammograms, the key procedure to screening.

The National Cancer Institute estimates that 226,870 women will be diagnosed with and 39,510 women will die of cancer of the breast in 2012. The number of new cases has increased every year for the past thirty years, though death from breast cancer has decreased slightly. Breast cancer remains the second leading cause of cancerous death after lung cancer. It is also the second most common cancer among women after non-melanoma skin cancer.

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Risk Factors for Breast Cancer in Elderly Women

Breast Cancer and The ElderlyAs the population ages, an increasing fraction of women diagnosed with breast cancer will be elderly. Heterogeneity of breast cancer risk factors between pre- and postmenopausal women is recognized, but few studies have examined elderly women specifically. The authors describe the age-specific influence of risk factors for postmenopausal breast cancer, with emphasis on women aged 75 or more years. Among 36,658 members of the Iowa Women’s Health Study (1986–2001), a population-based cohort study, 428 incident breast cancers were diagnosed in women aged 55–64 years, 1,297 in women aged 65–74 years, and 561 in women aged 75–84 years. Women with a body mass index (weight (kg)/height (m)2) in the highest versus the lowest quartile were at increased risk of breast cancer at age 75 or more years (adjusted hazard ratio = 1.44, 95% confidence interval (CI): 1.12, 1.84). Family history of breast cancer (hazard ratio = 1.54, 95% CI: 1.24, 1.93 for a first-degree family history vs. none) and an older age at menopause (ptrend = 0.07) conferred increased risk for women aged 75 or more years, and a high number of livebirths was protective (hazard ratio = 0.67, 95% CI: 0.51, 0.88 for five or more births compared with one or two). Obesity, a modifiable risk factor, remained positively associated with breast cancer for all age groups of postmenopausal women.

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Treating the Elderly Patient with Breast Cancer

A pooling of clinical trials by the NSABP (National Surgical Adjuvant Breast and Bowel Project) showed that elderly women tolerated and benefited from adjuvant chemotherapy. But in real life, the dilemmas are much harder.

Most of the time elderly women develop a subtype of breast cancer that is relatively less aggressive – node negative, ER+ and or PR+, with a high cure rate and benefit from hormonal therapy. It is when there are multiple nodes involved that adjuvant chemotherapy may increase the chance of cure – and this is a harder problem to overcome.

Dr. Hyman Muss from the University of Vermont has written extensively on the treatment of elderly women with breast cancer. There is a chronological age (e.g. 72, 75, 81) and a “biologic” age for patients. So a woman who is 72 may actually be healthier than many 52 year olds. These patients in general can tolerate more aggressive therapy better. We also refer to this at times as “performance status” meaning how vigorous a patient appears.

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Elderly women with early-stage breast cancer live longer with radiation therapy and surgery

Breast Cancer and The ElderlyElderly women with early-stage breast cancer live longer with radiation therapy and surgery compared with surgery alone, researchers at the University of Maryland School of Medicine have found. The researchers, who collected data on almost 30,000 women, ages 70 to 84, with early, highly treatable breast cancer enrolled in a nationwide cancer registry, are reporting their findings at the 54th annual meeting of the American Society for Radiation Oncology (ASTRO).

“Overall survival and breast cancer-specific survival were significantly better at all time points for elderly women with Stage I, estrogen-receptor (ER)-positive breast cancer with no lymph node involvement who received radiation therapy following surgery to remove the tumor,” says lead author Randi J. Cohen, M.D., M.S., an assistant professor of radiation oncology at the University of Maryland School of Medicine and a physician in the Department of Radiation Oncology at the University of Maryland Marlene and Stewart Greenebaum Cancer Center.

For women who had radiation and a lumpectomy, the overall survival rate was 88.6 percent at five years, 65 percent at 10 years and 39.6 percent at 15 years. That compares with a survival rate of 73.1 percent at five years, 41.7 percent at 10 years and 20 percent at 15 years for women who only had surgery. The median survival was 13 years for patients receiving surgery and radiation, compared with 9.9 years for patients receiving surgery alone. The researchers don’t know how many of the women also received hormonal therapy.

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Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris was born in Europe but has lived in the US for many years. He attended college both in Europe and the US and completed medical school at the University of Texas. Residency and fellowship in oncology was completed at Baylor. Read More...
Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton