Friday September 5, 2003
By Megan Rauscher
NEW YORK (Reuters Health) – Older women with breast cancer are being denied lifesaving treatment for breast cancer solely because of their age, results of a study of some 480 women suggest.
In the study, women over age 50 with early stage breast cancer were significantly less likely to be given “adjuvant” chemotherapy — that is, in addition to surgery and other treatments — researchers from Ohio State University in Columbus report in the journal Cancer.
The finding fuels the belief that age bias contributes to undertreatment of older women with breast cancer.
A number of past studies have already shown that older women are less likely to be treated with adjuvant chemotherapy, Dr. Charles L. Shapiro and colleagues say. But until now it hasn’t been clear what impact a woman’s age has on the decision to use or withhold adjuvant chemotherapy.
They theorized that taking into account “all of the relevant factors” that go into the decision to use chemotherapy — including the size of the tumor, whether it responds to anti-estrogen therapy or not, whether the disease has spread to the lymph nodes, and underlying health problems — older age would be a less important factor in the decision to use adjuvant chemotherapy.
“To our surprise, we found the opposite was true,” Shapiro told Reuters Health. “Controlling for all the relevant factors, older age becomes a more important factor, with older women less likely to get chemotherapy,” he said.
Women older than 65 with tumors that do not respond to estrogen, so-called ER-negative tumors, were about seven times less likely to be treated with chemotherapy than women younger than 50. This worries Shapiro, because these women do not benefit from estrogen therapy. “For them, chemotherapy is the only option,” he said.
Women with ER-positive breast cancers between the ages of 50 and 65 were six times less likely to be offered chemotherapy and those over 65 were 62 times less likely to receive it than women younger than 50.
“Over the next 25 years, doctors and women will increasingly face this decision, as the population of early stage breast cancer patients over age 65 will increase,” Shapiro told Reuters Health.
“Hopefully, this work will stimulate larger studies that examine the attitudes and preferences of older women and their physicians with respect to the use of adjuvant chemotherapy,” he added.