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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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