Age a factor in cervical cancer treatment

Elderly women with invasive cervical carcinoma are less likely to receive aggressive treatment than younger patients, and are more likely to die from the disease, a new study shows.

Given increasing evidence that older women tolerate radical hysterectomy and aggressive radiation treatment relatively well, the findings suggest that advanced age alone should not be a reason to rule out such treatment, the study's lead author, Dr. Jason D. Wright of Washington University in St. Louis, told AMN Health.

Used to treat gynecologic cancer, radical hysterectomy involves the removal of the uterus, cervix, the upper part of the vagina and other nearby tissue.

Wright and his colleagues looked at 1582 patients treated between January 1, 1986 and July 31, 2003, 197 of whom or 12.5 percent were 70 or older. While 54 percent of patients younger than 70 had surgery, just 16 percent of older patients did.

The difference was sharpest among women with stage IB and IIA disease, the researchers found. Seventy-five percent of younger women with this type of tumor were treated with radical surgery compared with 24 percent of the older women.

Older women were also nine times more likely than younger women to skip treatment completely. While the older patients had roughly double the risk of death compared to their younger counterparts, there was no association between age and recurrent or persistent disease after taking into account the stage of the tumor, the characteristics of the tumor, and treatment.

"There are definitely biases against giving these elderly patients aggressive treatments," Wright noted, adding that older patients themselves tend to be less likely to want such treatment.

"The discrepancy in treatment for women with cervical carcinoma is likely multifactorial and reflects both physician and patient preferences," he and his colleagues write. "Given the fact that geriatric patients often tolerate treatment well, aggressive therapy for patients with cervical carcinoma should not be withheld based on age alone."

SOURCE: Cancer, January 1, 2005.