Older women have worse survival from breast cancerResearchers from Sweden have found that women aged 70-84 years have up to a 13% lower chance of surviving breast cancer than those aged 50-69 years. In paper published in the open access medical journal PLoS Medicine, they show that this difference in survival appears to be due to differences in diagnosis and treatment, rather than the presence of other illnesses. In older women, the diagnosis of breast cancer was often made later than in younger women, and once diagnosed, older women were less likely to be fully investigated for their cancer, and had less aggressive treatment.
The researchers, led by Sonja Eaker from the University of Uppsala compared the 5-year relative survival for 9059 women with breast cancer aged between 50 and 84 years. They divided them into two groups: 50-69 year olds, and 70-84 year olds. They also categorised the women according to the stage of breast cancer. They looked at differences between how quickly the breast cancer cells divided, estrogen receptor status, the number of lymph nodes examined and whether there was lymph node involvement. The researchers also compared types of treatment – ie, surgical, oncological (radiotherapy, chemotherapy or hormonal) and the type of clinic the patients were treated in.
The team found that records for older women tended to be less complete. Older women were less likely to have their cancer detected by mammography screening, and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients. Older women were also less likely to be offered breast conserving surgery, but they were more likely to be given hormone treatment, such as tamoxifen even if the tumours did not show sign of hormone sensitivity.
Breast cancer is the most common cancer in women in much of the developed world. The disease is rare in women under 30, and the risk of breast cancer increases with age. Sonja Eaker and colleagues' findings suggest that there are great differences in the diagnosis and care of women with breast cancer, with older women faring much worse than younger women. In an accompanying perspective Eduardo Franco from McGill University asks: "to what extent do we as a society want to continue to assign lesser importance to our elderly when formulating health policies and research priorities?"
Citation: Eaker S, Dickman PW, Bergkvist L, Holmberg L, the Uppsala/Örebro Breast Cancer Group (2006) Differences in management of older women influence breast cancer survival: Results from a population-based database in Sweden. PLoS Med 3(3): e25.
Department of Surgery
Regional Oncologic Centre
Uppsala, Sweden SE-751 85
Related PLoS Medicine Perspective article:
Citation: Franco EL (2006) Epidemiology as a tool to reveal inequalities in breast cancer care. PLoS Med 3(3): e48.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030048
PRESS-ONLY PREVIEW OF THE PERSPECTIVE: http://www.plos.org/press/plme-03-03-franco.pdf
Eduardo L. Franco
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