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Contrary to the widely held belief that breast cancer tends to be less active in elderly women, researchers from the University of Chicago have found that breast cancer is equally aggressive in women of all ages. The study, which was presented at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting in October 2000, suggests that patients should be treated according to characteristics of their breast cancer tumors, such as tumor size and lymph node status, with less emphasis on their age. Previous studies have found that elderly women do not typically receive aggressive treatments such as chemotherapy or radiation therapy in addition to breast cancer surgery. To conduct the study, Dr. Rachana Singh of the University of Chicago Hospitals and her colleagues analyzed medical records from women treated with mastectomy (surgery to remove the breast) from 1927 to 1987. Women who were treated with adjuvant therapy, treatment such as chemotherapy or radiation therapy in addition to surgery, were excluded from the study. In the end, 1248 women between the ages of 40 and 70 and 182 patients over age 70 were studied. The majority of the patients in the study were treated with modified radical mastectomy, which involves removing the breast and some of the axillary (underarm) lymph nodes. After analyzing the patient data, the researchers found that the aggressiveness of breast cancer was similar in all age groups. This appeared to be true regardless of whether or not the lymph nodes were involved. Dr. Singh and her colleagues found that the metastagenicity (the likelihood that breast cancer will develop in distant regions in the body) was also similar in all women whose cancer had spread to the lymph nodes. However, the metastagencity was slightly higher in women over age 70 whose lymph nodes were free of cancer, than in younger women with cancer-free lymph nodes. According to the researchers, tumor size and lymph node status does affect a breast cancer tumor’s aggressiveness, but age appears to be less of a factor. Therefore, many elderly women with breast cancer should receive aggressive breast cancer treatment. While some physicians believe that aggressive cancer therapy is riskier in older patients and that very elderly women (over age 80) are more likely to die of another ailment related to old age, such as heart disease, than breast cancer, the American Cancer Society reports that 10,000 women over age 80 will die of breast cancer this year. In fact, several recent studies reveal that elderly women are not offered aggressive breast cancer treatments. For example, in a study conducted at 29 hospitals across the United States, researchers studied 718 women 67 years of age or older with breast cancer. Dr. Jeanne S. Mandelblatt of Georgetown University School of Medicine and her colleagues found that those women over age 80 were less likely to be recommended for radiation therapy than the women between 67 and 79 years of age. Furthermore, among those women who had breast-conserving surgery (lumpectomy) for their cancer, the women over age 80 were 70% less likely to receive chemotherapy than younger patients and were 3.4 times less likely to receive radiation after lumpectomy. Since the average risk of breast cancer recurrence is 40% within 10 years of breast-conserving surgery in post-menopausal women, Dr. Mandelblatt and her colleagues were surprised to find that many elderly women do not receive chemotherapy or radiation therapy in addition to breast cancer surgery. Age is one of the leading risk factors for breast cancer. As a woman increases in age, her risk of breast cancer also increases. Approximately 77% of women with breast cancer are over 50 years of age at the time of diagnosis while women in their twenties account for only 0.3% of all breast cancer cases. The breast tissue in younger women is usually denser, which can make the detection of small cancers on mammograms more difficult. Thus, breast cancer may be found at a later stage in young women, when it has developed to a more aggressive state. To help detect cancer at an early stage when it can be more easily and successfully treated, the American Cancer Society, the American Medical Association, the American College of Radiology, and other several healthcare organizations and associations recommend that all women begin receiving annual screening mammograms once they reach 40 years of age, in addition to practicing monthly breast self-exams and receiving annual clinical breast exams.
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