May lead to undertreatment: myths abound regarding breast Ca in the elderly.(Gynecology)

SAN ANTONIO -- Breast cancer in the elderly is often undertreated due to a series of misconceptions that are common among physicians and the public, Dr. Ian Fentiman asserted at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

One such misconception concerns life expectancy. Today a 75-year-old woman in the United States or Western Europe will live on average for another 12 years. An 80-year-old woman has a life expectancy of 9 years.

"That's plenty long enough for a relapse to occur in a patient whose breast cancer isn't treated properly," noted Dr. Fentiman, professor of surgical oncology at Guy's Hospital, London.

Other prevalent misconceptions regarding breast cancer in the elderly include:

* Myth: Elderly women typically have slow-growing tumors, so it doesn't much matter how they're treated. Actually, a recent Italian study of more than 14,000 primary breast cancers in older women demonstrated that the proportion of lymph node-negative tumors peaked at age 65-74 and tailed off among older women, probably because the elderly are less likely to undergo mammographic screening and early detection. Although the proportion of estrogen receptor-positive tumors amenable to tamoxifen therapy climbed with age, even among the oldest patients fully 20% of tumors were estrogen receptor negative (Crit. Rev. Oncol. Hematol. 45[3]:313-25, 2003).

A Guy's Hospital study showed that 30% of women above the age of 70 had grade 3 tumors indicative of more aggressive disease.

* Myth: It's unkind to intervene aggressively in elderly patients because they're typically frail, can't tolerate the rigors of treatment, and won't live long anyway. In a Surveillance, Epidemiology, and End Results study involving more than 18,000 breast cancer ...