Surviving Breast Cancer After Menopause
Feb. 20, 2001 -- Whether or not a woman wins the battle against breast cancer depends on many things. Researchers have now found that, at least for a woman after menopause, age and the presence of other diseases may affect her chances for survival.
Breast cancer is the second leading cause of cancer deaths among women, and it is estimated that there will be nearly 200,000 new cases in 2001. While breast cancer occurs in all age groups, the hardest hit are postmenopausal women. More than three-quarters of all deaths from this disease occur in women over the age of 55, and as age goes up, the chances of survival decrease.
According to a study published in the Feb. 21 issue of the Journal of the American Medical Association, not only do older women have a higher death rate, but age and the presence of other diseases may influence both treatment decisions and overall assessment of the cancer.
Treating an older population needs to be more individualized, says study author Jerome W. Yates, MD. Factors involved in treatment may include both physical and, in some cases, social factors, which will help the physician determine the best method of treatment, he says. Yates is a senior vice president at Roswell Park Cancer Institute in Buffalo, N.Y.
The researchers looked at records of 1,800 postmenopausal women with breast cancer. Nearly three-quarters of them had been diagnosed with early stage cancer.
The National Institutes of Health (NIH) has a set of guidelines known as the NIH Consensus Statement for Treatment of Early Breast Cancer, which doctors use when deciding on therapy for their patients. While almost all of the women in the study had received treatment in accordance with these guidelines, therapy given to the older patients had been less consistent with the NIH consensus.
For example, women in the older groups were less likely to have received radiation therapy after a partial mastectomy, even though younger patients had.
A procedure called axillary lymph node dissection is a common surgery used to determine the extent of disease in patients with early stage breast cancer. This involves removing underarm lymph nodes that drain fluids from the breast. Fewer axillary lymph node dissections were performed on women 70 and older.
And when the procedure was performed in this age group, the patients tended to receive more extensive surgery than younger women. Older women had a greater chance of having a modified radical rather than the less disfiguring partial mastectomy.
However, the authors do not specifically say that older patients were denied treatment because of their age, Christopher Benz, MD, tells WebMD. "What the article does not say is that patients who are over the age of 55 are being treated inappropriately," he says, "And that's a conclusion that some would read into this." Benz, who was not involved in the study, is a professor of medicine at the University of California, San Francisco, and a breast cancer specialist.