Breast cancer in the elderly

Management of elderly patients with breast cancer: the time for surgery

INTRODUCTION

Most patients with breast cancer are likely to benefit from local treatment (surgery and/or radiotherapy). Historically an arbitrary cut-off of 70 years has been widely used, above which women were considered for tamoxifen-only treatment. We looked at the proportion of our patients who did not have early surgery for breast cancer to see if this cut-off might have been used too rigidly, resulting in suboptimal treatment of some patients over 70 years of age. A step change in the rate of surgical treatment around age 70 was sought as evidence.

METHOD

A total of 2209 consecutive patients with confirmed histological diagnosis of breast cancer were identified; 677 of these did not have surgery within 3 months of diagnosis. Analysis determined age group distribution and the reasons for no surgery or delayed surgery.

RESULTS

A step increase in the number of patients not undergoing early surgery was clearly seen at 70 years of age.

CONCLUSION

Age may have been used too rigidly to decide local treatment for elderly patients with breast cancer. Comprehensive multidisciplinary assessment is needed to make informed decisions and to optimize management of elderly patients.

Women's knowledge and beliefs regarding breast cancer

Approximately 20-30% of women delay for 12 weeks or more from self-discovery of a breast symptom to presentation to a health care provider, and such delay intervals are associated with poorer survival. Understanding the factors that influence patient delay is important for the development of an effective, targeted health intervention programme to shorten patient delay. The aim of the study was to elicit knowledge and beliefs about breast cancer among a sample of the general female population, and examine age and socio-economic variations in responses. Participants were randomly selected through the Postal Address File, and data were collected through the Office of National Statistics. Geographically distributed throughout the UK, 996 women participated in a short structured interview to elicit their knowledge of breast cancer risk, breast cancer symptoms, and their perceptions of the management and outcomes associated with breast cancer. Women had limited knowledge of their relative risk of developing breast cancer, of associated risk factors and of the diversity of potential breast cancer-related symptoms. Older women were particularly poor at identifying symptoms of breast cancer, risk factors associated with breast cancer and their personal risk of developing the disease. Poorer knowledge of symptoms and risks among older women may help to explain the strong association between older age and delay in help-seeking. If these findings are confirmed they suggest that any intervention programme should target older women in particular, given that advancing age is a risk factor for both developing breast cancer and for subsequent delayed presentation.