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Older Breast Cancer Patients Getting Insufficient Treatment

A new study reports that many older breast cancer patients are being under-diagnosed, and that they are getting insufficient treatment, especially in community hospitals.

The problem is becoming more urgent because breast cancer is becoming more common as the number of middle-aged and elderly people grows.

The study, published in the October edition of the Archives of Surgery, analyzed the medical records of 354 women who were 70 or older, and who were diagnosed with cancer in a community hospital between 1992 and 2002.

The Findings

Drs. Rajeev Arora and David A. Litvak of Michigan State University found that in about 56 percent of breast cancer cases, the cancer could not be detected in a standard physical examination. The study also found that mammograms were not being conducted often enough citing that while 72 percent of the patients studied had received mammograms, they were mostly just used to verify physical exam results.

According to the study, 36 percent of women, and 56 percent of women 80 or older were never examined to determine if the cancer had spread to their lymph nodes.

Insufficient Treatment

The study’s authors found that while half of breast cancer patients had surgery to preserve their breasts, chemotherapy, radiation, and hormone therapy were being administered much less often than expected, and that older women especially received these treatments less often than they should.

“There are misconceptions by the public and the medical community that it’s OK to omit certain diagnostic tests or treatments in older patients,” said Litvak.

“Older people are in a special category, which means that we have to be careful about how we treat them and how we approach their cancer,” he added.

The study found that only 29 percent of cancer patients whose cancer had spread to the lymph nodes received chemotherapy.

The study’s authors said that older patients should be assessed to determine an estimated life expectancy, and to predict how the patient might react to different types of cancer treatment.

“The bottom line is that we really have to start individualizing the care of older patients,” said Litvak. “It doesn’t make sense to have a cap on mammograms for age. It should be based on the patients’ overall health and their life expectancy. The same is true for treatment.” He added, “Most older patients tolerate and benefit from the same treatments that younger patients get … You just have to be careful how you give it.”

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