Risk of Death From Breast Cancer Higher Among Older Patients
David Cohen, M.D.·Published 9 February 2012·8 min read
Key points
Among postmenopausal women with hormone receptor-positive breast cancer, increasing age was associated with a higher risk of death from breast cancer, according to a study in the February 8 issue of JAMA.
Family history appears to be a risk factor even for older women.
According to both clinical observations and laboratory studies, breast cancer becomes more indolent in the aged.
"Breast cancer is the leading contributor to cancer incidence and cancer mortality in women worldwide, with 1,383,500 new cases in 2008.
Among postmenopausal women with hormone receptor-positive breast cancer, increasing age was associated with a higher risk of death from breast cancer, according to a study in the February 8 issue of JAMA.
"Breast cancer is the leading contributor to cancer incidence and cancer mortality in women worldwide, with 1,383,500 new cases in 2008. In the United States in 2008, 41 percent of these women were aged 65 years or older at diagnosis. Because breast cancer incidence increases with increasing age, changing demographics and continuously increasing life expectancy will further enlarge the number of older women confronted with breast cancer," according to background information in the article. "In addition to classic tumor-related prognostic factors, patient characteristics may be associated with breast cancer outcome."
Willemien van de Water, M.D., of the Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a study to assess disease-specific mortality among age groups in postmenopausal patients with hormone receptor-positive breast cancer. The study consisted of an analysis of 9,766 patients enrolled in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) randomized clinical trial between January 2001 and January 2006. Age at diagnosis was categorized as younger than 65 years (n = 5,349), 65 to 74 years (n = 3,060), and 75 years or older (n = 1,357).
During median (midpoint) follow-up of approximately 5.1 years, there were a total of 1,043 deaths. The number of deaths was 391 (7.3 percent) in patients younger than 65 years, 341(11.2 percent) in patients ages 65 to 74 years, and 311 (22.9 percent) in patients ages 75 years or older. Cumulative incidence of death due to breast cancer increased from 5.7 percent in patients younger than 65 years, 6.3 percent in patients 65 to 74 years of age, to 8.3 percent in patients 75 years or older.
Increasing age was associated with a lower number of deaths due to breast cancer as a proportion of all-cause mortality (less than 65 years, 77.5 percent; 65-74 years, 56.3 percent; 75 years or older, 36.3 percent). Additional analysis indicated that compared with patients younger than 65 years, disease-specific mortality increased with age for patients ages 65 to 74 years and patients 75 years or older.
Risk Factors for Breast Cancer in Older Women
Family history appears to be a risk factor even for older women. However, familial prevalence does not necessarily imply inheritance, because environmental conditions in the same household (e.g., dietary habits, substances in the air) hypothetically may cause a cluster of cancers in a family. Only a negligible proportion of breast cancers in older women are associated with known genetic mutations.
Risk Factors for Breast Cancer
Written and revised by
David Cohen, M.D.
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According to both clinical observations and laboratory studies, breast cancer becomes more indolent in the aged. Thus, as women age, the prevalence of non–life-threatening metastases appears to increase, while the incidence of life-threatening metastases tends to decrease. The risk of death due to metastatic disease also decreases with advancing age.
One explanation for the more indolent course of breast cancer in older women is that the prevalence of hormone-receptor–rich, well-differentiated and slowly proliferating neoplasms increases with age. The ability of the host to support tumor growth may also decrease with age.
The researchers also found that mortality from other causes increased with age, and that increasing age was associated with a higher risk of breast cancer relapse.
The authors speculate that a possible underlying mechanism that may help explain the age-specific outcome in this relatively healthy population is that older patients may experience undertreatment, and in particular undertreatment of either chemotherapy or radiotherapy.
"In conclusion, regardless of a higher risk of other-cause mortality and independent of tumor and treatment characteristics, disease-specific mortality increases with age among postmenopausal women with hormone receptor-positive breast cancer. These data underline the need for age-specific breast cancer studies in order to improve breast cancer outcome in patients of all ages. Moreover, future detailed population-based and translational studies may increase insight into causal factors of higher disease-specific mortality and breast cancer relapse with increasing age," the researchers write.
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According to the National Breast Cancer Foundation, 200,000 new cases of breast cancer will be diagnosed each year in the US, making it three times more common than other gynecological cancers.
Breast cancer will claim the lives of 40,000 people this year.
What is really disturbing is the speed at which breast cancer rates have risen over the past 5 decades. In 1960, one in twenty women were diagnosed—but today, it is one in seven.
The following are some important facts about this type of cancer:
One woman in eight who lives to age 85 will develop breast cancer.
Breast cancer is the leading cause of death for women age 40 to 55.
Fifteen percent of all breast cancers occur in women under age 45; in this age group, breast cancers are more aggressive and have lower recovery rates.
Eighty percent of breast lumps are NON-cancerous.
Seventy percent of breast cancers are found through breast self-exams.
About 80 percent of women diagnosed with breast cancer have no family history of breast cancer.
Unfortunately, the current medical paradigm is relatively clueless about what causes breast cancer and how to effectively treat it. Most conventional cancer treatments actually add insult to injury by doing more harm than good - a fact that up to this point has been swept under the rug by the medical industry.
U.S. Breast Cancer Statistics About 1 in 8 U.S. women (just under 12%) will develop invasive breast cancer over the course of her lifetime.
In 2011, an estimated 230,480 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 57,650 new cases of non-invasive (in situ) breast cancer.
About 2,140 new cases of invasive breast cancer were expected to be diagnosed in men in 2011. A man’s lifetime risk of breast cancer is about 1 in 1,000.
From 1999 to 2005, breast cancer incidence rates in the U.S. decreased by about 2% per year. The decrease was seen only in women aged 50 and older. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy (HRT) by women after the results of a large study called the Women’s Health Initiative were published in 2002. These results suggested a connection between HRT and increased breast cancer risk.
About 39,520 women in the U.S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness.
For women in the U.S., breast cancer death rates are higher than those for any other cancer, besides lung cancer.
Besides skin cancer, breast cancer is the most commonly diagnosed cancer among American women. Just under 30% of cancers in women are breast cancers.
White women are slightly more likely to develop breast cancer than African-American women. However, in women under 45, breast cancer is more common in African-American women than white women. Overall, African-American women are more llkely to die of breast cancer. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.
In 2011, there were more than 2.6 million breast cancer survivors in the US.
A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 15% of women who get breast cancer have a family member diagnosed with it.
About 5-10% of breast cancers can be linked to gene mutations (abnormal changes) inherited from one’s mother or father. Mutations of the BRCA1 and BRCA2 genes are the most common. Women with these mutations have up to an 80% risk of developing breast cancer during their lifetime, and they are more likely to be diagnosed at a younger age (before menopause). An increased ovarian cancer risk is also associated with these genetic mutations.
In men, about 1 in 10 breast cancers are believed to be due to BRCA2 mutations, and even fewer cases to BRCA1 mutations.
About 85% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.
The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).
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Breast cancer in older patients Breast cancer is a common problem and a major health concern in our growing geriatric population. Older breast cancer patients are at risk for less than standard management, the appropriateness of which is difficult to discern. Breast tumors tend to have less aggressive characteristics. In addition, planning therapy is not always straightforward because older patients may present with comorbid illnesses and frailty that limit therapeutic choices. Standard management approaches should always be considered first. Here, we outline some data supporting standard treatment for breast cancer in older women. We also describe other options that can be considered in circumstances when the standard treatment is not possible. For instance, primary treatment with tamoxifen or an aromatase inhibitor is justifiable in a patient who is unfit for surgery and axillary dissection may be unnecessary in a patient who is obviously unfit for adjuvant chemotherapy. Adjuvant therapies should be considered, weighing risks and benefits for each patient, though the threshold for using chemotherapy may be higher. The goals in treating metastatic breast cancer in an older patient are not different than for younger patients.
### Kimmick G, Muss HB.
Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. PMID: 15112153 [PubMed - indexed for MEDLINE]
(JAMA. 2012;307[6]:590-597. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The TEAM trial was supported by an unrestricted grant from Pfizer. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc
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