Outcomes in Older Women with Breast Cancer

Among postmenopausal women with hormone receptor-positive breast cancer, the likelihood of dying from breast cancer increases with age. These results were published in the Journal of the American Medical Association. ?

Of the more than 200,000 cases of breast cancer diagnosed each year in the United States, roughly 40 percent occur in women over the age of 65. Research that explores how breast cancer outcomes change as women age has the potential to improve care for this large group of women.?

To evaluate breast cancer outcomes by age, researchers analyzed information from a clinical trial known as TEAM (Tamoxifen, Exemestane, Adjuvant, Multinational). The study enrolled more than 9,700 postmenopausal women with non-metastatic, hormone receptor-positive breast cancer. All women were treated with surgery and hormonal therapy. Decisions about chemotherapy and/or radiation therapy were left to the treating physician.?

Women were followed for just over five years.?

Death from breast cancer occurred in 5.7 percent of women under the age of 65, 6.3 percent of women between the ages of 65 and 74, and 8.3 percent of women age 75 or older.?Older women continued to be more likely to die from breast cancer even after the researchers accounted for tumor characteristics and other factors known to affect outcomes.??

One of the possible explanations for the worse breast cancer outcomes among older women involves treatment. Studies have suggested that older women are less likely than younger women to received standard breast cancer treatments, possibly due to concern that about the ability of older women to tolerate these treatments. In the current study, for example, 48 percent of the oldest women had breast cancer that had spread to the lymph nodes, but only 5 percent received chemotherapy. Older women were also less likely than younger women to receive radiation therapy after a lumpectomy.?

Although older women in this study were more likely to die of breast cancer than younger women, it should be noted that most women—regardless of their age—did not die of breast cancer. It should also be noted that all of the women in this study were postmenopausal. This study did not address cancer outcomes in premenopausal women.?

Reference: van de Water W, Markopoulos C, van de Velde CJH et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307:590-597.?

Posted February 10, 2012

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