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Lack
of care for older breast cancer patients
Older women with breast cancer get a lower level of care than
younger women, researchers at The University of Manchester have
found.
Compared to younger women, older women with breast cancer are less
likely to be diagnosed via needle biopsy and triple assessment, less
likely to undergo surgery and less likely to receive radiotherapy,
the researchers report in this week's British Journal of Cancer.
Such management of older women is likely to lead to higher rates of
local recurrence of the disease and higher than necessary mortality.
Dr Katrina Lavelle, who led the study at the University's School of
Nursing, Midwifery and Social Work, explains: "We have found that
older women from aged 70 and over are less likely to receive the
same breast cancer care as younger women and that this is related to
their age rather than differences in the biology of their tumour."
The highest incidence of breast cancer in England
occurs in women aged 70 years and older. Older women
also experience the worst survival - women aged
70-79 have a 76% five-year relative survival
compared to 80% for all ages, and for women aged 80
plus this drops considerably to 61%, beyond what
might be expected owing to an increase in age.
The team carried out a retrospective cohort study involving case
note review based on the North Western Cancer Registry database of
women aged 65 and over, resident in Greater Manchester with invasive
breast cancer registered over a one year period.
The results of the study, funded by an NHS R&D
Training Fellowship, may be generalized nationally
as variation in survival between regions is lower
for breast cancer compared to other cancers.
They found that, compared to women aged 65-69 years, women aged 80
plus with operable breast cancer have increased odds of not
receiving triple assessment, not receiving primary surgery, not
undergoing axillary node surgery and not undergoing steroid receptor
tests (which indicate suitability for hormone therapy).
Compared with her 65-69-year-old counterpart, the odds of a woman
aged 80 or older not receiving triple assessment for operable breast
cancer are five-and-a-half times higher, and the odds of her not
receiving surgery are more than 40 times higher.
Even women as young as 70-74 have over 7 times the odds of not
receiving radiotherapy following breast conservation surgery
compared to women aged 65-69 years. In addition, the team discovered
that the overall percentage of women in all the age groups not
receiving steroid receptor tests was high at 41%, which resulted in
treatment decisions being taken without this fundamental
information.
Three quarters of the patients who did not receive steroid receptor
tests were given the hormone therapy, tamoxifen: that is, prescribed
a treatment without evidence that it would work. In a survey of UK
breast cancer surgeons in 2004, 75% reported that they would treat
older breast cancer patients in a similar way to younger patients
and 98% responded that the cut off point for breast cancer surgery
was not age related.
Dr Lavelle says: "Clearly there is a difference in clinicians'
perceptions of how older breast cancer patients should be treated
and their actual practice. "Standard management of breast cancer was
infrequent in older women in Greater Manchester. The lack of
diagnostic and steroid receptor testing resulted in older cancer
patients having no effective treatment with 41% not undergoing a
steroid receptor test, 32% of whom received tamoxifen as their sole
form of treatment.”
"Mortality of elderly breast cancer patients is unlikely to improve
where this pattern of management persists."
Research lead for the School of Nursing, Midwifery and Social Work,
Professor Chris Todd, commented: "It would be wrong to conclude that
ageism is to be found in the NHS on the basis of these results
alone, as this study has not been able to take the preferences of
older women themselves into account. This is something we intend to
investigate in the next phase of our research."
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