The National Institutes of Health (NIH) consensus statement recommends adjuvant therapy for early breast cancer irrespective of age. However, the actual use of such therapy is not well documented among women over 65 years of age.
Methods
We studied the frequency of use of adjuvant therapy and report the receipt of this therapy among 200 women aged ≥65 years diagnosed with early breast cancer who were identified from the New Jersey State Cancer Registry.
Results
In this population, 28% of patients received chemotherapy alone or in combination with hormonal therapy, whereas 42% received hormonal therapy alone. Less than half of the women with estrogen receptor-negative tumors received chemotherapy alone or in combination with hormonal treatment. Adjuvant therapy was not prescribed in 30% of patients.
Conclusions
Despite NIH recommendations, the frequency of use of adjuvant therapy in New Jersey is low among women over 65 years of age, regardless of their receptor status.
References
1.
Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists’ Collaborative Group.Lancet.1992; 339: 71–85.
2.
Adjuvant Therapy for Breast Cancer.National Institutes of Health Consensus Development Conference Statement. November 1-3, 2000. Available at http://consensus.nih.gov/cons/114/114_intro.htm. Accessed November 12, 2006.
3.
CascinuS., Del FerroE., CatalanoG.. Toxicity and therapeutic response to chemotherapy in patients aged 70 years or older with advanced cancer.Am J Clin Oncol.1996; 19: 371–374.
4.
LashT.L., SillimanR.A., GuadagnoliE.. The effect of less thandefinitive care on breast carcinoma recurrence and mortality.Cancer.2000; 89: 1739–1747.
5.
DuX.L., KeyC.R., OsborneC.. Discrepancy between consensus recommendations and actual community use of adjuvant chemotherapy in women with breast cancer.Ann Intern Med.2003; 138: 90–97.
6.
GreeneF.L., PageD.L., FlemingI.D., eds. AJCC Cancer Staging Manual.6th ed.New York, NY: Springer; 2002.
7.
CharlsonM.E., PompeiP., AlesK.L.. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis.1987; 40: 373–383.
8.
de la Haba RodriguezJ.R., Mendez VidalM.J., Gomez EspanaA.. Adjuvant treatment in elderly patients with breast cancer: critical review of clinical practice.Am J Clin Oncol.2003; 26: 398–401.
9.
DuX., GoodwinJ.S.. Patterns of use of chemotherapy for breast cancer in older women: findings from Medicare claims data.J Clin Oncol.2001; 19: 1455–1461.
10.
GuadagnoliE., ShapiroC., GurwitzJ.H.. Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer.J Clin Oncol.1997; 15: 2338–2344.
11.
MandelblattJ.S., HadleyJ., KernerJ.F.. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences.Cancer.2000; 89: 561–573.
12.
MerchantT.E., McCormickB., YahalomJ.. The influence of older age on breast cancer treatment decisions and outcome.Int J Radiat Oncol Biol Phys.1996; 34: 565–570.
13.
Controlled trial of tamoxifen as adjuvant agent in management of early breast cancer.Interim analysis at four years by Nolvadex Adjuvant Trial Organisation.Lancet.1983; 1: 257–261.
14.
Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer.Analysis at six years by Nolvadex Adjuvant Trial Organisation.Lancet.1985; 1: 836–840.
15.
Adjuvant tamoxifen in the management of operable breast cancer: the Scottish Trial. Report from the Breast Cancer Trials Committee, Scottish Cancer Trials Office (MRC), Edinburgh.Lancet.1987; 2: 171–175.
16.
Controlled trial of tamoxifen as a single adjuvant agent in the management of early breast cancer. “Nolvadex” Adjuvant Trial Organisation.Br J Cancer.1988; 57: 608–611.
17.
DelozierT., SpielmannM., Mace-Lesec'hJ.. Tamoxifen adjuvant treatment duration in early breast cancer: initial results of a randomized study comparing short-term treatment with long-term treatment. Federation Nationale des Centres de Lutte Contre le Cancer Breast Group.J Clin Oncol.2000; 18: 3507–3512.
18.
Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials.Lancet.2005; 365: 1687–1717.
19.
Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group.Lancet.1998; 351: 1451–1467.
20.
RhodesA., JasaniB., BarnesD.M.. Reliability of immunohisto-chemical demonstration of oestrogen receptors in routine practice: interlab-oratory variance in the sensitivity of detection and evaluation of scoring systems.J Clin Pathol.2000; 53: 125–130.
21.
SmithR.E., GoodB.C.. Chemoprevention of breast cancer and the trials of the National Surgical Adjuvant Breast and Bowel Project and others.Endocr Relat Cancer.2003; 10: 347–357.
22.
ElwoodJ.M., GodolphinW.. Oestrogen receptors in breast tumours: associations with age, menopausal status and epidemiological and clinical features in 735 patients.Br J Cancer.1980; 42: 635–644.
23.
MandalaM., MoroC., FerrettiG.. Effect of tamoxifen on GH and IGF-1 serum level in stage I-II breast cancer patients.Anticancer Res.2001; 21: 585–588.
