Elderly women with breast cancer at greater risk of dying from disease

2011 European Multidisciplinary Cancer Congress

Breast cancer mortality increased with higher age, although the chance of dying from other causes was higher in elderly patients.

"For those not suffering from other conditions or those who have survived other conditions, deaths from breast cancer are higher compared to younger patients with the same tumor characteristics," study researcher Christos Markopoulos, MD, said in a press release. "This probably means that old women with breast cancer are being undertreated, as doctors think they will die from something else."

Markopoulous, an associate professor of surgery at Athens University Medical School in Greece, and colleagues conducted a study to assess competing mortality in 9,766 postmenopausal women who were enrolled on the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial. Women on this trial were randomly assigned to exemestane 25 mg daily for 5 years or tamoxifen 20 mg daily for 2.5 to 3 years, followed by exemestane 25 mg daily for 2 to 2.5 years. There was no difference in outcome between the two groups.

After 5.1 years of follow-up, a multivariable analysis showed a higher proportion of breast cancer specific and non-breast cancer related mortality with increasing age (P,.001). When taking into account the risk of a competing mortality, the researchers confirmed higher breast cancer mortality with higher age.

"Underlying this situation is a false perception that the outlook for older women with breast cancer is relatively good," Markopoulos said. "This false impression is most likely due to deaths from other age-related conditions. Several other studies have shown that elderly breast cancer patients have lower odds of receiving standard care, including deviations from guidelines for surgery, radiotherapy and chemotherapy. More work should be done to clarify the picture in the elderly population."

For more information:

Markopoulos C. #5015. Presented at: The 2011 European Multidisciplinary Cancer Congress; Sept. 23-27; Stockholm, Sweden.

Although this study confirms that causes not related to breast cancer are the main reasons for death, it also suggests the likelihood that the diverse nature of the hormone-positive disease plays a role, too. We need to improve the breast cancer prognostic classification in the elderly, developing specific tools or implementing those developed for younger patients, in order not to deprive those who might derive a real benefit from additional treatment, including chemotherapy.

- Etienne Brain, MD
Hôpital René Huguenin, Institute Curie, France

Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.

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