Elderly breast cancer patients often are underdiagnosed, undertreated

November 15, 2015

David Litvak of Kaiser Permanente Medical Center of Orange County, Calif., and colleagues analyzed the records of 354 breast cancer patients ages 70 or older. The patients were diagnosed with breast cancer from 1992 through 2002, and researchers compared data from three age subgroups -- 70 to 74, 75 to 79, and 80 and older. The patients in each subgroup had the same median tumor size and were in the same stage of disease, according to the study (Litvak, Journal of the American Medical Association's Archives of Surgery, October 2006). The study finds that 46% of all the patients came to their physician with breast cancer that could be detected by a physical examination, while 62% of women in the oldest age group had breast cancer identifiable by a physical exam. About 60% of women in oldest age group received mammograms mainly to confirm the results of the physical exam, compared with 72% of all the women studied. The findings indicate that older women are less likely to receive regular mammograms than younger women, the Journal reports. Some official agencies recommend breast cancer screenings up to age 70, while others have no limit, according to the study.

Seventy percent of the women in the study were in the early stages of cancer based on first diagnosis. Evaluation of lymph nodes to determine the cancer's progression -- which is often conducted for younger patients -- was not performed for 36% of patients, including 56% of patients ages 80 and older, the study finds. In addition, rates of chemotherapy, radiation and hormonal therapy among the women were the lowest in the oldest age group (Wall Street Journal, 10/17). About half of the women received breast-conserving surgery, but only 45% received chemotherapy, which researchers said is a lower percentage than expected for younger patients, Reuters Health reports (Reuters Health, 10/16). "Unfortunately, part of (the problem) may be due to physicians' attitudes toward treating older people," Litvak, who conducted the study when he was at Michigan State University, said, adding, "There is an underlying belief that older people can't tolerate treatments that we use in younger people. But as the population has aged, 80 years old now can mean that people still have 10 or more years of life expectancy." He added that many decisions are being made by doctors and patients based on "an inaccurate perceived notion of what older people can and cannot tolerate" (Wall Street Journal, 10/17).

This article is republished with kind permission from our friends at the The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork, a free service of The Henry J. Kaiser Family Foundation. 2006 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The Department of Health's advisory committee on breast cancer screening which carried out a comprehensive evaluation of the programme, found that for every 2,000 women joining it over 10 years, five lives would be prolonged.

The NHS says that breast screening saves 1, 400 lives each year and that women who were screened were less likely to have a mastectomy than those who were not screened and the benefits of breast screening far outweigh the risks.

Dr Peter Gotzsche, the director of the Nordic Cochrane Centre has described the NHS statement that screening led to a reduction in the number of mastectomies as "misleading".

Another expert Professor Michael Baum, a long-term critic of screening, has called on the NHS programme to be independently assessed by the National Institute for Clinical Excellence, in the same way that the breast cancer drugs arimidex and herceptin were.

In 2001, the same authors concluded there was no convincing evidence that screening programmes reduce mortality from the disease.

The report is published in the Cochrane Library.