A large study has found that women older than 65 diagnosed with early-stage, hormone-receptor-positive breast cancer had worse outcomes than younger women with similar diagnoses. The research was published in the Feb. 15, 2012 issue of the Journal of the American Medical Association.
Nearly 9,800 women participated in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) trial:
- 1,357 were 75 or older
- 3,060 were age 65 to 74
- 5,349 were younger than 65
All the women were diagnosed with early-stage, hormone-receptor-positive breast cancer. All had surgery to remove the cancer and then got hormonal therapy according to the study's protocol. Some of the women got other treatments, such as radiation therapy and chemotherapy, as directed by their doctors. The women were followed for different periods of time after diagnosis. Half were followed for more than 5 years and the other half were followed for fewer than 5 years.
Older women were more likely to die during the study's follow-up period. By age range, the proportion of women who died from breast cancer was:
- 8.3% 75 or older
- 6.3% age 65 to 74
- 5.7% younger than 65
The risk of recurrence also was greater for the older women. Compared to women younger than 65, recurrence was:
- 7% more likely among women age 65 to 74
- 29% more likely among women 75 or older
Other research has shown that that older women get as many benefits from breast cancer treatment as younger women. Still, research also has shown that doctors tend to treat breast cancer in older women less aggressively than similar breast cancer diagnosed in younger women. Less aggressive treatment might explain, at least in part, why older women had worse outcomes in the TEAM trial.
For example, even though 48% of women age 75 or older had breast cancer spread to nearby underarm (axillary) lymph nodes, only 5% got chemotherapy after surgery. Women with breast cancer spread to axillary lymph nodes usually get chemotherapy after surgery to reduce recurrence risk.
The reasons why older women may not always get the most optimal treatment aren't clear. It could be because of the personal treatment preferences of individual older women. Personal preference is a very important factor in planning any woman's treatment plan, at any age. Still, less aggressive treatment in older women could be because doctors assume older women may not handle treatment side effects as well as younger women. Doctors also may assume that aggressive treatment isn't wanted or doesn't make sense because a woman is older.
Most older women diagnosed with early-stage breast cancer who are otherwise in good health are likely to live for many years to come. So there's no reason to be less aggressive when it comes to breast cancer treatment. Everyone, no matter their age, deserves the best care available.
If you're an older woman and have been diagnosed with breast cancer, be sure to talk to your doctor about ALL the treatment options available to you. Ask your doctor about any age-related assumptions that may be influencing your treatment plan and tell your doctor your personal preferences about treatments that make the most sense for YOU.