Surviving Breast Cancer After Menopause
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.
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.