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Very Elderly Women with Breast Cancer Less Likely to Receive Tamoxifen (dateline April 24, 2003)

According to a newly published study, very elderly breast cancer patients are less likely to be prescribed the drug tamoxifen to help treat their cancer, compared to younger women. Tamoxifen, brand name Nolvadex, has been used for more than a quarter century to treat breast cancer and reduce the risk that the disease will recur. Other studies have found that elderly women with breast cancer are often treated with less aggressive treatments even though they are more likely than younger women to die from breast cancer.

In the current study, Sarah B. Blackman, MPH, of Boston Medical Center, and colleagues studied 92 women diagnosed with early-stage breast cancer at four different centers in the United States. They compared the results of a medical record review and two telephone interviews of women between 85 to 92 years of age with women 80 to 84 years of age. The study was reported in the December 15th issue of the journal Cancer.

The results showed that women in the 85 to 92 age group were found 26% less likely to receive a prescription for tamoxifen, compared to the women 80 to 84 years of age. These results took into account other medical conditions such as heart disease, diabetes, high blood pressure, and stroke, which are more common among elderly patients, and found that these factors did not influence the likelihood of a tamoxifen prescription. In fact, women who suffered from several medical conditions were more likely to receive tamoxifen than women who did not.

Because tamoxifen is associated with a number of side effects, most notably hot flashes but also blood clots and increased risk of stroke, physicians may be more weary of prescribing the drug to very elderly women. In addition, physicians may feel that very elderly breast cancer patients are unlikely to live long enough to benefit from taking tamoxifen. However, the American Cancer Society estimates that approximately 10,000 women over age 80 will die of breast cancer this year.

Recent studies have found similar results with respect to breast cancer treatment among the elderly. In a year 2000 study conducted at 29 hospitals across the United States, researchers studied 718 women 67 years of age or older with breast cancer. Dr. Jeanne S. Mandelblatt of Georgetown University School of Medicine and her colleagues found that those women over age 80 were less likely to be recommended for radiation therapy than the women between 67 and 79 years of age. Furthermore, among those women who had breast-conserving surgery (lumpectomy) for their cancer, the women over age 80 were 70% less likely to receive chemotherapy compared to younger patients and were 3.4 times less likely to receive radiation after lumpectomy. Since the average risk of a breast cancer recurrence is 40% within 10 years of breast-conserving surgery in post-menopausal women, the researchers were surprised to find that many elderly women do not receive chemotherapy or radiation therapy in addition to breast cancer surgery.

Age is one of the leading risk factors for breast cancer. As a woman increases in age, her risk of breast cancer also increases. Approximately 77% of women with breast cancer are over 50 years of age at the time of diagnosis while women in their twenties account for only 0.3% of all breast cancer cases.

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