Surviving Breast Cancer After Menopause
For example, Benz points out that the study doesn't tell us if the women were also receiving the drug tamoxifen, a common treatment for patients who have the type of breast cancer that responds to it. This cancer is very common in women over the age of 50, says Benz, and this type of therapy is often given regardless of what stage the cancer is in.
"So if you're going to treat someone with the same type of treatment regardless of the staging, do you have to take out their lymph nodes?" asks Benz, since the procedure itself can often produce complications.
"It is quite possible that many of them would have been put on tamoxifen, and the decision not to remove lymph nodes was based on that, rather than their age," he says.
Benz also adds that the decision to have a mastectomy rather than just removing the tumor may have also had to do with their other health problems and patient preference.
"When a partial mastectomy or lumpectomy is done," he explains, "the patient is generally treated with daily radiation therapy for a six-week period."
Older people may have problems getting to the hospital to have their daily radiation therapy. And with a mastectomy, they have their surgery and are done with it, he says, and cosmetic results may be less of a concern. "So the higher incidence of modified radical mastectomy in this population might be a combination of the patient's and doctor's choice -- of what will work better for the patient," he says.
Unfortunately, the study was not designed to be able to tell why patients did or did not get certain treatments, says Yates. "We don't know from this data what circumstances determined the treatment," he says.
But he agrees with Benz that it was probably a combination of many factors, including patient preference.
The older the women were, the more likely they were to have another medical condition in addition to their breast cancer. The presence of illnesses such as kidney disease, liver disease, and stroke lowered their chances of surviving their breast cancer. In fact, a number of the women died from causes other than breast cancer. It appeared that the older the women were, the more likely they were to die from an illness such as heart disease, rather than their breast cancer.
"The real message here is that we have all of these other competing problems, and we have to have some sort of objective way -- something other than age alone -- to be able to factor in for medical decision making in a 70-year-old," says Benz.
"It's important to find a doctor who has had experience treating patients with breast cancer," says Yates, "and who can discuss the different treatment options and what the advantages and disadvantages may be. The most important thing is that a woman sees someone who is prepared to sit down and discuss the options."