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Some Senior Breast Cancer Patients Don't Get Full Treatment

By June 28, 2011

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Women over age 66 with metastatic breast cancer don't always get the full range of post-mastectomy treatments. A study done at MD Anderson Cancer Center in Houston showed that almost half of all senior women with advanced breast disease do not get radiation therapy after their surgery.

The researchers sifted through data from 38,000 women older than 66 who had a mastectomy between 1999 and 2005. In the group that was studied, 8,000 patients had metastatic breast cancer, but fewer than 4,000 had radiation in addition to surgery. Guidelines recommending that radiation be offered to women with advanced disease after a mastectomy were published during the six years that this study covered. So experts recognized the benefits of radiation for breast cancer, even after a breast is removed - remember that the chest wall and lymph nodes may be affected - but many women didn't get the additional treatment. Dr. Benjamin Smith, a co-author on this study, considered the possible reasons behind these results.

Many patients may have been offered radiation, but decided not to take it. Before the guidelines were published, most oncologists considered radiation to be ineffective after a mastectomy. So a historical prejudice against post-mastectomy radiation may have stood in the way of additional treatment for some women.  In other cases, women who were over 80 years old seemed to be least likely to take radiation after breast surgery. These patients may considered the tradeoffs between quality of life and longevity, and decided that life during six or more weeks of radiation - plus recovery time - did not seem like their best choice.  The women may not have lived within close distance to a radiation clinic, so driving or staying in a hotel during treatment may have not been an option. Cost of treatments and access to health insurance could also be a factor.

If you were age 66 or older at diagnosis, would you want the full range of treatments for advanced breast cancer?  Or would you prefer to stick with the basic surgery and chemotherapy that many patients opt for?  What would influence your decision?  Please leave your comments below.

Comments
June 29, 2011 at 8:58 am
(1) Martha says:

I am 83 years old and have declined chemotherapy after a mastectomy. I plan to take some radiation treatment and am taking anastrozole.

June 29, 2011 at 9:03 am
(2) Gloria says:

I’m over 65 and just had my first chemo treatment. It left me feeling terrible from the start. Cancer treatments can be hard and less well tolerated the older you get. I understand why and support those over 65 who refuse portions of their treatments, for whatever reason.

June 29, 2011 at 10:14 am
(3) Marjorie says:

I read this retrospective study when it was published in the journal, Cancer.

First, the media has terribly skewed the basic facts. The reasons why older women did not receive radiation are not known and they did not have advanced cancer or metastatic cancer. They were considered to be high risk due to a larger tumor size with 1-3 positive nodes.

It was also not the majority of older women in the study as reported by the media but a subset of the overall group. About 20% of the overall dataset studied did not receive radiation. That is not “most older women”. The majority of that 20% subset did not get radiation but most did receive chemotherapy. This is a drawback in retrospective analysis. It can show a possible trend but not explain why.

The authors of this study acknowledged drawbacks in this kind of data mining. It’s impossible to determine if the reasons were patient driven or physician driven yet the sound bytes skewed it to stir medical distrust and perhaps create pressure to push use of radiation.

It’s also worth noting that this study was underwritten by a company that markets radiation equipment.

The bottom line is that the headlines aren’t completely truthful and this was an industry driven study.

June 29, 2011 at 10:52 am
(4) Cheryl says:

I have 3 separate cancers in my left breast(one DCIS 2 IDC’s.) I just had a biopsy of my left shoulder (that showed up for increased activity on PET scan).
If the shoulder is positive for cancer,Dana Farber Cancer Institute says they will only recommend me having hormone therapy. No radiation,chemo,surgery,because if it’s in my shoulder,it has probably “seeded” elsewhere,and is just not growing yet.
If it is not in my shoulder they will do everything and try for a “cure”.

June 29, 2011 at 12:55 pm
(5) Catherine Slaughter says:

At age 68 I was diagnosed with stage 1 breast cancer. My medical team (surgeon, oncologist, radiologist) recommended 12 weeks of chemotherapy to shrink the tumor, then surgery (lumpectomy), then 7 weeks of radiation. I decided to follow those recommendations. Examination of two lymph nodes during surgery showed only one node questionable, so it was determined there was no metastasis.
I am glad I agreed to undergo radiation because of all the treatments, it was the least problematic for me.
I am now 73 and nearing year 5 in my recovery. All of my mammograms have been clear.
I assume recommendations of radiation may be different for those whose cancer is more advanced and has metastisized. Therefore, I cannot say what my decision about radiation therapy would have been if my diagnosis had been different.

June 29, 2011 at 2:17 pm
(6) Ann says:

At 70, I have several medical issues (stemming from birth defects + age.) My Dr’s. decided against radiation for two reasons. One there was no cancer in the sentinal nodes, & two the radiation might be more harmful (with my others medical problems) than it would be good. I’m glad my Doctors chose a path based on the things I deal with & that they explained the reasoning behind their choices. It helps to know why. One size doesn’t fit all, & my Doctors have been grand to treat me as an intelligent person with value, & I feel I’ve gotten good care, not dealt with “…age prejudice…” & I feel extremely blessed to have had such good & truly kind, care. As an older patient I’ve found it helps to be informed & aware & to ask questions if they are appropriate. It helps to have a list of other Doctor’s, (names, address’, phone numbers) & a list of medicine taken. This can be done on the home computer & updated as needed. Doctors have limited amount of time to spend with each patient. It’s good if the patient realizes this & can use that Dr./patient time wisely.

July 6, 2011 at 9:04 am
(7) Mary Anne says:

I had DCIS with an extension into the lobes but it had not spread outside of my breast although it was through-out the breast. I did have a mastectomy with no radiation or chemo. They got it all. All this happened at age 64. If I were past 66 and if it had spread, yes, I would have the radiation. I know of other women who have undergone both chemo and radiation (my sister-in-law at age 50) and while it is hard no matter what the age, I’d do it. I am not ready to call it quits at any age without a damn good fight.

July 6, 2011 at 12:30 pm
(8) Jayne says:

I am 85 yrs old now, & had a mastectomy just over 3 years ago, and I had both chemo and radiation, and would do it again. I am still active in many ways, in clubs, and with friends in various activities. And I am enjoying it all, My husband died last year, from Alzheimer’s, so I have had that loss to cope with. I have also had 2 knee replacements and a hip replacement, but that hasn’t slowed me down much, either. When I walk into the hospital for my checkups the nurses laugh and say “here comes the bionic woman!” So I laugh back and thank God for all that medical science can do these days–and enjoy whatever time I have left.

July 6, 2011 at 3:42 pm
(9) M. Case says:

Way to go…Jayne…..best to all of you ladies….

July 7, 2011 at 4:40 pm
(10) Alicia says:

You go, Jayne!! I find you very inspiring!

I’m 54 & have just been diagnosed w/ breast cancer. I think my feelings if I were older would be still be the same as they are now: I want whatever helps & extends my life as long as the QUALITY is insured for as long as possible.

July 8, 2011 at 4:00 am
(11) Margaret says:

I would definately opt for the full treatment. I was diagnosed with BC in Jan 10. I was 68 and 8 months old. My first appointment with my surgeon stunned me when he said if I had been 70 he would have to weigh up the benefits of treatment or not. The thing was I was very healthy and exercised 3 times a week at a gym as well as walking approx 6 kilometres 5 times a week. He explained exactly what treatment I would have and I opted for the lot. I did’nt finish all my treatment until late 0ct. I had 16 chemo treatments over 6 months 30 treatments of radiation over 6 weeks. My body was not ravaged I have been in very good health this year. Thank God.

July 10, 2011 at 10:43 am
(12) Helen says:

I was diagnosed with stage 2 breast cancer three years ago at age 77.I had a lumpectomy and two lymph nodes removes.there was no cancer in the lymph nodes but more cells were found too close to the borders so another operation was performed on my breast.i had 16 sessions of radiation and am now on tamoxifen.
I see the medical oncologist every 4 months and radiation oncologist every 6 months.He recommended mammograms every 6 months until 6 months ago and now he recommended once a year.
My age was never mentioned as a factor in my treatment.i feel that I am given excellent care.

i

July 11, 2011 at 12:29 pm
(13) Natalie says:

Wow, thanks for sharing your findings with us all, Pam, and thank you everyone else for your input and reactions. It’s really interesting to see how everyone’s experiences and feelings on treatment can vary so much. It’s clear that as cancer survivors, all of you understand the incredible impact impact a cancer diagnosis has on women with the disease, as well as their families. At the CSC (Cancer Support Community) we are trying to better understand the emotional and social needs of breast cancer survivors, at all stages of their cancer journey–please consider sharing your experiences and joining our national movement: http://www.BreastCancerRegistry.org

Best wishes for you all,
Natalie

July 19, 2011 at 8:43 pm
(14) Carol Wishes says:

I am a breast cancer patient at Kaiser Permanente and, though I am 65, the full range of treatment was recommended from day one. I was given a choice on the chemo–I could have chosen to skip it, but chemo gave an extra 15% outright cure–but lumpectomy and radiation always were recommended. I feel Kaiser’s aggressive approach is the right way to go, and I commend them for caring enough about patients to do the very best. Also, the state of California ranks Kaiser first (with four stars) above all other private insurers (including Anthem and Blue Cross) for the quality of its breast cancer treatment.

May 11, 2012 at 5:52 pm
(15) Kathryn says:

I would want the full range of treatments. Both my mother and aunt over age 80 when they got breast cancer were no even offered chemo and not offered radiation for their breast cancer. We thought the HMO just wanted to save money instead of save lives.

May 19, 2013 at 11:23 am
(16) Victoria says:

IT DEPENDS OF AGE, A PERSON OVER 80 IS LESS SUITABLE AND WEAK TO HAVE A SURGERY IN THE FIRST PLACE LET ALONE RADIATION.

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