Elderly breast cancer patients risk treatment discrimination

Stockholm, Sweden: Women diagnosed with breast cancer late in life are at greater risk of dying from the disease than younger patients, assuming they survive other age-related conditions, according to a study to be presented at the 2011 European Multidisciplinary Cancer Congress on Saturday. The results point to shortcomings in patient care for elderly women as well as differences in the progress of the disease.

Researchers led by Professor Christos Markopoulos from Athens University Medical School (Athens, Greece) used the population of the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial to examine competing causes of death in post-menopausal women with early breast cancer. Participants were treated with exemestane for five years or tamoxifen for 2.5 years followed by exemestane for 2.5 years. This use of the data was possible because, after five years, the trial had found no difference in outcomes between the two treatments it was comparing.

The 9,766 patients were classified by their age at diagnosis, separating those below 65 years of age, those between 65 and 75, and those above 75. All patients had hormone receptor positive tumours, 50% had node negative disease, 68% received radiotherapy, and 36% received chemotherapy.

An analysis of their progress over the 5.1 years of the trial found that although the risk of dying from causes other than breast cancer was much higher in elderly patients, the risk of dying of breast cancer also increased with age.

Applying a statistical method that takes into account the risk of competing causes of death in the elderly population, it was found that the risk of dying from breast cancer was indeed greater for those diagnosed later in age.

According to Prof. Markopoulos, who is also Chair of the Hellenic Society of Breast Surgeons, the higher absolute death rate amongst elderly women with breast cancer suggests they are not receiving standard treatment. "Our findings show that elderly breast cancer patients are more likely to die from something else other than from breast cancer – for instance, age specific co-morbidities such as heart attack. However, for those not suffering from other conditions or those who have survived other conditions, deaths from breast cancer are higher compared to younger patients with the same tumour characteristics," he explains. "This probably means that old women with breast cancer are being under-treated as doctors think they will die from something else."

Several factors which can cause breast cancer mortality with increasing age, such as an age specific decrease in the function of the immune system on tumour progression, could potentially affect the results but cannot be easily assessed, says Prof. Markopoulos. "However, we observed that radiotherapy was administered less frequently and administration of chemotherapy sharply decreased with increasing age. Thus, it is most likely that under-treatment of the elderly may explain the worse age-specific breast cancer outcome found in our study," he says.