A study, published in the Journal of Clinical Oncology, is one of the first of its kind to assess the benefits and improvements in medicine and technology for treating women with Breast Cancer through the last thirty years.

Looking specifically at age subsets in the data, Benjamin Smith, M.D., assistant professor in MD Anderson’s Department of Radiation Oncology, and his colleagues, set out to identify if women of all ages are benefiting from Breast Cancer Treatment.

Unfortunately, it seems that more elderly women are not party to the benefits that should be provided by the new treatments available – this new data will provide researchers with a targeted age group to focus on in the future.

Professor Smith says :

“What surprised me was just how different the outcomes of older women are compared to those of other age groups … In almost all other subsets, we found improvements that cluster in a similar direction, but older women are on a very different slope as far as the minimal improvement they’ve experienced.”

The study looks at two parameters : The rate and risk of breast cancer death in the general population in newly diagnoses patients, and comparing this over time and across age spectrums. The data was collected by the Centers for Disease Control and Prevention (CDC), and published in the National Vital Statistics Report annually from 1980-2007. The CDC report categorized the rate of breast cancer death into four age groups: 20-49; 50-64; 65-74, and 75 and older. The Surveillance, Epidemiology, and End Results (SEER) registry, compiled by the National Cancer Institute was used to analyze the risk of breast cancer death from a cohort of 219,024 women ages 20 and older diagnosed from 1980-1997.

The result show that :

  • Death rates were stable throughout the 1980s for women ages 20-64, but increased for women ages 65 and older.
  • Between 1990 and 2007, the largest decrease in death rates was seen in women ages 20-49 at 2.4 percent per year.
  • The smallest decrease in breast cancer death rates was seen in women ages 75 and older, at 1.1 percent per year.
  • Black women with breast cancer are not seeing improvements in outcomes, evidenced by an absolute death rate in 2006 that was 38 percent higher than whites.

Prof. Smith attributed the large decrease from 1990 to 2007 to the widespread introduction of routine mammograms and said :

“We found that the oldest women, regardless of their race, and blacks, regardless of their age, are not benefiting as much from improvements in breast cancer treatments.”

Prof. Smith also explains that less lethal estrogen receptor positive cancers are more frequent in older women, yet outcomes have still improved more rapidly for younger women who have a larger proportion of biologically aggressive disease. This suggests outcomes are less linked to tumor biology than they are to possible suboptimal treatment.

The study didn’t get into the root causes, but Smith suggests that lower mammogram rates for older women combined with limited knowledge of optimal treatment resulting from under-representation or exclusion in clinical trials; and chemotherapy toxicity, which limits the ability to deliver therapy at recommended dosages, may well be partially to blame.

Smith concludes :

“Given the fact that breast cancer is growing rapidly, we really need to focus research exclusively on developing optimal treatments for older women with breast cancer, evaluating how we can predict which older women can tolerate treatments, and develop new treatments that work better.”

Written by Rupert Shepherd.