Older women with breast cancer are less likely to be diagnosed via needle biopsy and triple assessment, less likely to undergo surgery and less likely to receive radiotherapy than younger women, researchers report in this week's British Journal of Cancer.
Such management of older women is likely to lead to higher rates of local recurrence of the disease and higher than necessary mortality.
Dr Katrina Lavelle, who led the study at the University of Manchester, explains: "We have found that older women from aged 70 and over are less likely to receive the same breast cancer care as younger women and that this is related to their age rather than differences in the biology of their tumour."
The highest incidence of breast cancer in England occurs in women aged 70 years and older. Older women also experience the worst survival.
The team carried out a retrospective cohort study involving casenote review based on the North Western Cancer Registry database of women aged 65 and over - residents in Greater Manchester with invasive breast cancer registered over a one year period.
They found that, compared with women aged 65–69 years, women aged 80 plus with operable breast cancer have increased odds of not receiving triple assessment, not receiving primary surgery, not undergoing axillary node surgery and not undergoing steroid receptor tests (which indicate suitability for hormone therapy. Even women as young as 70–74 have over seven times the odds of not receiving radiotherapy following breast conservation surgery compared with women aged 65-69 years.
In addition, the team discovered that the overall percentage of women in all the age groups not receiving steroid receptor tests was high at 41%, which resulted in treatment decisions being taken without this fundamental information. Three quarters of the patients who did not receive steroid receptor tests were given the hormone therapy, tamoxifen, ie, prescribed a treatment without evidence that it would work.
In a survey of UK breast cancer surgeons in 2004, 75% reported that they would treat older breast cancer patients in a similar way to younger patients and 98% responded that the cut-off point for breast cancer surgery was not age related.
Dr Lavelle says: "Clearly there is a difference in clinicians' perceptions of how older breast cancer patients should be treated and their actual practice.
"Mortality of elderly breast cancer patients is unlikely to improve where this pattern of management persists."
Research lead for the School of Nursing, Midwifery and Social Work, Professor Chris Todd, comments: "It would be wrong to conclude that ageism is to be found in the NHS on the basis of these results alone, as this study has not been able to take the preferences of older women themselves into account. This is something we intend to investigate in the next phase of our research."
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