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A recent study finds that elderly breast cancer patients who had breast conserving surgery (lumpectomy) were more likely to
report a better quality of life than patients who had their entire breasts removed with a mastectomy procedure. Despite findings of previous studies
which show that chances of surviving early stage breast cancer are equal, regardless of
which type of breast cancer surgery patients undergo, elderly patients are still more
likely to be undergo mastectomy operations. The current study shows that a more
complicated surgery such as mastectomy is not usually necessary for these patients.
To conduct their study, Dr. J. C. J. M de Haes, of the Academic Medical Hospital in
Amsterdam, The Netherlands and colleagues gave quality of life questionnaires to elderly
patients (average age: 70) who had either underwent breast-conserving surgery, in which
only the breast cancer tumor and a surrounding margin of normal tissue is removed, or
mastectomy, in which the entire breast is removed. The researchers asked the women about
several issues, including: fatigue, emotional functioning, fear of recurrence, social
support, physical functioning, and leisure time activities.
While the study did not show any difference in terms of survival based on the type of
surgery the women had, Dr. de Haes and colleagues did find that women who underwent
breast-conserving surgery were less likely to experience arm pain and tended to see
themselves as having a better body image, compared to women who underwent mastectomy.
Thus, the researchers conclude that breast-conserving surgery is a viable option for most
elderly breast cancer patients with early-stage breast cancer.
The women who had breast-conserving surgery were also given the drug tamoxifen after surgery.
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. 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. Physicians may also feel that very elderly
breast cancer patients are unlikely to live long enough to benefit from taking tamoxifen.
Previous studies have found that elderly breast cancer patients are often not treated
aggressively enough with adjuvant (additional) therapies, such as chemotherapy,
radiation, or tamoxifen in addition to their
surgery. Some physicians believe that aggressive cancer therapy is riskier in older
patients and that women over the age of 75 are more likely to die of another ailment
related to old age, such as heart disease, before the effects of breast cancer become
devastating. However, the American Cancer Society estimates that approximately 10,000
women over age 80 will die of breast cancer this year.
Age is one of the leading risk factors for breast cancer. As a woman increases in age,
her risk of breast cancer also increases; seventy-seven percent of women with breast
cancer are over 50 years of age at the time of diagnosis while women ages 20 to 29 account
for only 0.3% of all breast cancer cases.
To help detect cancer at an early stage when it can be more easily and successfully
treated, the American Cancer Society, the American Medical Association, the American
College of Radiology, and other several healthcare organizations and associations
recommend that all women begin receiving regular mammograms
once they reach 40 years of age, in addition to practicing monthly breast
self-exams and receiving annual clinical breast
exams.
Additional Resources and References
- The report, "Quality Of Life In Breast Cancer Patients Aged Over 70 Years,
Participating in the EORTC 10850 Randomised Clinical Trial," is published in the May
2003 edition of The European Journal of Cancer (Vol. 39, Issue 7), http://www.medicinedirect.com/journal/journal?sdid=5024
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