Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Abstract

BACKGROUND The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received. METHODS A stratified random sample was selected among women age ≥ 50 newly diagnosed with lymph node negative breast carcinoma in Québec in 1988, 1991, and 1993. Information was abstracted from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast‐conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple logistic regression analysis. RESULTS Overall, 1174 patients age ≥ 50 years with breast carcinoma were included. Women age ≥ 70 years were much less likely to receive definitive locoregional treatment compared with women ages 50–69 years (48.7% vs. 83.5%; P < 0.0001). Older women were less likely to undergo surgery with breast preservation (76.7% vs. 86.3%; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 64.7%; P = 0.41). Adjusting for comorbidity and other characteristics related to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12–0.18 for women age ≥ 70 years vs. women ages 50–69 years). The same association was observed when women who did not undergo lymph node dissection but who received systemic adjuvant treatment were considered to have received definitive therapy (OR, 0.13; 95% CI, 0.10–0.17) for women age ≥ 70 years vs. women ages 50–69 years). CONCLUSIONS Less aggressive patterns of care are provided to elderly breast carcinoma patients, independent of comorbidity. This could explain, at least in part, the sustained breast carcinoma mortality in this population. Cancer 1999;85:1104–13. © 1999 American Cancer Society.

Non-standard management of breast cancer increases with age in the UK: a population based cohort of women ⩾65 years

“…This has been cited in the guidelines as a legitimate reason for non-standard management of older women (SIGN, 1998;NWBG, 1999). Several studies provide evidence that this disparity in treatment still occurs when comorbidity is accounted for (Hérbert-Croteau et al, 1999;Du and Goodwin, 2001;Yancik et al, 2001;DeMichele et al, 2003;Nagel et al, 2003;Gennari et al, 2004;Giordano et al, 2005). However, few control for any further measures of general health (Silliman et al, 1997;Mandelblatt et al, 2000;Hurria et al, 2003).…”

“…Compared to younger women, older women with breast cancer are less likely to be diagnosed via needle biopsy and triple assessment, less likely to undergo primary and axillary node surgery, less likely to receive radiotherapy following breast-conserving surgery, and less likely to receive chemotherapy (Busch et al, 1996;Hérbert-Croteau et al, 1999;Mandelblatt et al, 2000;Bouchardy et al, 2003;Gennari et al, 2004;Wyld et al, 2004;Giordano et al, 2005). Such management of older women is likely to lead to poor local control, recurrence of the disease and excess mortality (COIN, 1999;BASO, 2005;SIGN, 2005).…”

“…The evidence from such studies conducted in North American (Hérbert-Croteau et al, 1999;Mandelblatt et al, 2000;Du and Goodwin, 2001;Yancik et al, 2001;DeMichele et al, 2003;Giordano et al, 2005) and to a lesser extent mainland Europe (Bouchardy et al, 2003;Nagel et al, 2003;Gennari et al, 2004) suggests that age predicts non-standard management when tumour characteristics are accounted for. However, no similar studies have been undertaken in the UK and these results may not be representative of practice in the UK, especially in light of the comparatively lower survival rate of women aged X65 years compared to the rest of Europe (Vercelli et al, 2000) and the United States (ONS, 2002;Ries et al, 2003) and differences in health care services between countries.…”

Bevölkerungsbezogene Studie über die Anwendung adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom

“…Diese Beobachtung ist konsistent mit früheren Untersuchungen [2,10,11,16,17]. Guadagnoli et al [10] untersuchten in einer retrospektiven Kohortenstudie die Qualität der Versorgung von frühen Stadien des Mammakarzinoms in den amerikanischen Bundesstaaten Massachusetts und Minnesota.…”

Radiotherapy Confined to the Tumor Bed Following Breast Conserving Surgery

“…In other series, 15-30% of women treated with breast conserving surgery failed to receive radiotherapy [1,14,20,36]. Reasons for the under-utilization of this treatment approach include patient convenience, physician preference, and logistical problems [1,9,20]. Accelerated, limited field radiotherapy is an attractive treatment approach to shorten the standard 5-7 weeks course of whole breast radiotherapy to 4-5 days.…”