Breast Cancer and the Aging Patient

Breast cancer is the most common form of cancer found in older women. It has been reported that 80 percent of all breast cancer happens in women over the age of 50, and a staggering 60 percent of cases are reported in women over the age of 65.

The average age at diagnosis is 61 years. While a young woman in her 30s has but a one in 233 chance of being diagnosed, a woman in her 80s has a one in eight chance. Breast cancer is a formidable disease that must be mitigated by women of all ages through annual mammograms, especially since current statistics indicate many women are forgoing their annual screenings.
Fortunately, advances in care and treatment options have provided for significant increases in longevity. However, patients who are age 80 or older face a complex treatment plan that requires a solid understanding of the patient’s goals while simultaneously discussing the associated risks, potential effects of treatment, and any potential loss of quality of life. If caught early, though, breast cancer can be treated for a successful outcome about 98 percent of the time.

Breast Cancer in Seniors
Several issues exist regarding breast cancer in older women. First and foremost is lack of information. Older women are vastly underrepresented in clinical trials, mainly due to age restriction cutoffs and/or the requirement of only allowing healthy patients for the studies. This leaves information for best treatment options for this population somewhat blurry and undefined. As a result, evidenced-based guidelines cannot be readily established when it comes to treating older women with breast cancer. The toxicity levels of chemotherapy, which can result in heart failure and osteoporosis, for example, which can diminish one’s quality of life, have not been fully studied.

Other issues affecting senior women who are diagnosed with breast cancer can include difficulties with visiting their physician. The patient may not be able to drive herself or may not have someone who can take her to appointments. With aggressive treatment schedules, it can be challenging for one to attend to the six to eight weeks of daily trips to undergo therapies such as radiation.

The side effects of treatment also create additional hurdles. Older patients tend to suffer nausea from chemotherapy to a greater degree than their younger counterparts. Insurance, especially Medicare, can also be finicky when it comes to covering certain medications.

One Size Does Not Fit All
Current knowledge and understanding of breast cancer indicates the overall biology of the disease is not much different in older woman than in younger patients. While studies have evidenced older women can obtain the same benefits of treatment for breast cancer as younger women, some doctors tend to approach the disease in older women from a less aggressive stance. This could lead to less favorable outcomes for older women.

There are many reasons older women may get a different course of treatment than younger women, but those reasons are not always clear. Perhaps it could be related to one’s personal preference. Perhaps some doctors do not think an older woman can effectively tolerate certain treatment approaches and their potential side effects. Some physicians may even shy from an aggressive treatment plan because they don’t think it makes sense for an older woman. However, functionality must be taken into consideration. A very healthy and active 75-year-old woman might tolerate the standard course of treatment while another woman of the same age might be homebound for certain existing medical reasons and require daily care. As a result, one’s overall functionality can determine the effectiveness of a treatment approach.

Even though older patients are at an increased risk for greater side effects from treatment protocols, any patient who is undertreated, no matter the age, can realize poor outcomes. Therefore, it is important for the patient and the patient’s caregivers to fully discuss the goals of any treatment approach with their physician and oncologist. Clinicians should make treatment recommendations based on the patient’s functionality, existing co-morbidities, nutritional status, cognition, psychological state and social support, all balanced with the patient’s own values and preferences for treatment.

The Good News
Women who are diagnosed with breast cancer in its early stages but who are in relatively good health at the time of diagnosis can potentially live for many more years. As such, there is no reason to push aside the more aggressive treatment plan even if you are in the afternoon of life.
If you are an older woman who has been diagnosed with breast cancer, it is recommended you discuss all treatment options available and inquire about any age-related assumptions with respect to treatment that may determine the course of action for your case. ■

Sources: aging.com, bcrf.org, aplaceformom.com, breastcancer.org and ascopubs.org.