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Age Bias May Hinder Breast Cancer Care

Screening, Treatment Often Less Aggressive in Older Women With Breast Cancer

Reviewed by Louise Chang, MD on January 17, 2006
From the WebMD Archives

Jan. 17, 2006 -- Older women receive less aggressive screening and treatment for breast cancer than younger women, and they may be less likely to survive the disease as a result, new research from Sweden shows.

Women included in the study who were between the ages of 70 and 84 at diagnosis were up to 13% less likely to survive their breast cancer than women between the ages of 50 and 69.

The older women had mammography screening less often and their breast cancers tended to be diagnosed at a later stage. Once diagnosed, the older women also tended to get less aggressive treatment.

The findings are reported in the March 2006 issue of the journal PLoS Medicine.

"This is a very distressing finding, since around 30% of all breast cancer patients are above the age of 70," University of Uppsala epidemiologist Sonja Eaker and colleagues write.

'Age-Related Bias'

The researchers examined diagnostic, staging, treatment, and five-year survival data for 9,060 Swedish women diagnosed with breast cancer between the ages of 50 and 84.

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Eaker tells WebMD that she was not surprised to find that the older a woman was, the lower the probability that her cancer would have been detected by mammography screening. That is because in Sweden most women do not have mammograms after age 74. In many areas of the country, the cutoff is age 70, she says.

Cancer staging once the cancer was diagnosed was also less complete for the women who were age 70 and older, and treatment was less aggressive. The women tended to have fewer lymph nodes examined for cancer spread, and they were treated with radiation and chemotherapy less often, even though their tumors tended to be larger.

"It does appear that a significant age-related bias does exist," Eaker says.

70s Are Peak Age

This bias is likely to be more pronounced in the United States and other industrialized countries, says McGill University professor of epidemiology Eduardo Franco, PhD. That is because Sweden has one of the most comprehensive public health care systems in the world, and ability to pay does not influence access to care.

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"In the United States, and to a lesser degree in Canada where I live, cost considerations drive health care access," he tells WebMD. "If we see this type of age-driven disparity in Sweden it is not difficult to imagine that it is worse in other countries."

But American Cancer Society spokesman Len Lichtenfeld, MD, says because there is no age cutoff for mammography screening in the United States, it is impossible to say how applicable the Swedish findings are to this country.

"I was stunned to see that so few older women in Sweden got mammograms," he tells WebMD. "If they are excluding women from mammography screening because they are over a certain age, it isn't surprising that these women are going to have more advanced cancers when they are finally diagnosed."

Lichtenfeld concedes that older cancer patients in the United States often receive less aggressive treatment than younger ones. This is partly due to the fact that elderly patients may be more ill in general, with other medical problems that need addressing. But this does not entirely explain the treatment inequity.

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Many women also stop getting mammograms as they grow older, mistakenly believing that they are no longer at risk for breast cancer.

But Lichtenfeld points out that in the United States the peak years for breast cancer diagnosis are between age 75 and 79.

"Women tend to get more complacent about screening as they age," he says. "But that is exactly what they shouldn't do. Just because you are in your 70s don't think that your risk of breast cancer goes away."

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Sources

SOURCES: Eaker, S. PLoS Medicine, March 2006; vol 3, online edition. Sonja Eaker, epidemiologist, department of surgery, University Hospital of Uppsala and Regional Oncologic Center, Uppsala, Sweden. Eduardo L. Franco, PhD, professor of epidemiology and oncology; director, division of cancer epidemiology, McGill University, Montreal. Len Lichtenfeld, MD, deputy chief medical officer, American Cancer Society.
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