CHICAGO - With the graying of the population, practitioners would do well to look beyond age when it comes to treating older women for breast cancer, military researchers have concluded.
The general practice of skipping breast cancer treatment to women because of their age and comorbid conditions has been challenged by a study conducted at the Naval Medical Center in San Diego, CA and the Tripler Army Medical Center in Honolulu, HI.
According to the results presented at the RSNA meeting Monday, 58% of the 68 women in the study, ages 75 and over, died from the cancer even though 82% had comorbid medical conditions such as congestive heart failure, diabetes or coronary heart disease.
Many of those patients were not offered the aggressive treatments - radiation therapy, chemotherapy - that are standard in the younger population, said Dr. Peter Johnstone, head of the radiation oncology division and chair of the cancer committee at the Naval Medical Center.
Only patients with invasive breast cancer lesions were included in the study. Of the 68 patients, 50% underwent mastectomy, 44% were treated with lumpectomy and 9% had fine-needle aspiration only. Only 64% of the women over 75 had radiation therapy after lumpectomy, compared to 80% of the women in the overall population. Similarly, 60% of all patients received chemotherapy versus 17% of the patients in the study.
"We should not routinely deny standard treatment simply because a woman is over 75," Johnstone said. "Most (older) women would not refuse treatment." The average life expectancy of a woman over 75 is 11 years, he noted.
"We have to be able to quantify the comorbid condition so we can further individualize the patient's care," Johnstone said.
For instance, a patient with liver or kidney problems may not be able to tolerate chemotherapy. However, "I had a 94-year-old woman who had a breast (cancer) reoccurrence, but she was refused treatment at 90 because of her heart disease," Johnstone said.
While the majority of Johnstone's older patients were open to cancer therapy, he acknowledged that financial concerns were not an issue at a military hospital because personnel are given complete coverage. Managed care or Medicare may not be as responsive to treating older women because of costs.
"Can society afford to treat older patients? That is an argument that will be decided on a national level," he said.
Another issue is whether older women are proactive about breast health. Researchers at the Wake Forest University School of Medicine (Health Educ Behav 1999 Oct:26(5):625-647) found that only half of the 719 women age 60 and over who were surveyed underwent a mammogram in 1998.
By Shalmali Pal
AuntMinnie.com staff writer
November 30, 1999
