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OLDER WOMEN SHOULD BE TREATED FOR BREAST CANCER

CHICAGO -- New research flies in the face of conventional wisdom that older women with breast cancer should not bother to undergo therapy because they are more likely to die of another condition, such as heart attack or stroke, before the cancer kills them.

Doctors should not routinely minimize treatment of older women with breast cancer based purely on age and coexisting medical problems, suggests the study conducted at Naval Medical Center San Diego and Tripler Army Medical Center in Honolulu. The research is being presented here today at the 85thScientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

In the study, while more than 4 out of 5 women 75 and older diagnosed with breast cancer had other, potentially life-threatening medical conditions, such as high blood pressure, heart disease and diabetes, of those who died, 58 percent died from their cancer. Many of them had not been given the same level of aggressive treatment a younger woman generally receives.

"Doctors may feel that older women will probably die of something else before the breast cancer, or may consider older women too frail to treat aggressively," said Peter A. Johnstone, M.D., head of the radiation oncology division and chair of the cancer committee at the Naval Medical Center. "That's not always the case. These data show that we need to be more aggressive with therapy in older patients. People are living longer and better, and age and coexisting medical problems seem less important than we previously considered."

Records were reviewed of 68 women 75 or older, seen at the two large military teaching hospitals in a 10-year period: 30 (44 percent) were treated with lumpectomy (surgical removal of cancerous tissue), 34 (50 percent) had mastectomy (surgical removal of the entire breast); and 6 (9 percent) had only a biopsy of their tumor.

Only 64 percent of the women who had lumpectomy received radiation therapy, which is the generally considered standard treatment. Overall, more than 80 percent of U.S. women who have lumpectomy receive radiation therapy. Chemotherapy was given to only 17 percent of women whose cancer had spread to lymph nodes or elsewhere in the body. Chemotherapy is often recommended in younger women in such cases. Nationally, 60 percent of patients with advanced breast cancer receive it.

After three years, 24 of the patients (35 percent) died, 14 of them (58 percent) from breast cancer.

"Few of these women refused treatment. In most cases at these medical centers, cancer therapy recommendations were agreed upon at a multidisciplinary Tumor Board of cancer specialists. Nonstandard therapy in these cases may reflect widely held assumptions that aggressive therapy is riskier in older patients, or that patients may die of their other medical problems before the cancer progresses," said Dr. Johnstone. "Today, the life expectancy of a woman 75 years old is more than 11 years, and data from the American Cancer Society reflect that almost 10,000 women older than 80 will die of breast cancer this year."

These data correlate with a recent Institute of Medicine report that elderly women are less likely to receive radiation therapy after lumpectomy, and that chemotherapy is less often offered to them.

"Optimal cancer care at any center is achieved by continuous examination of existing methods as well as adaptations to new therapies," said Dr. Johnstone. "Baseline studies such as these show us our collective biases and allow us to better optimize and personalize therapy for each of our patients."

Co-authors of a paper on the topic being presented by Dr. Johnstone are: Brian D. Lawenda, M.D.; Robert H. Riffenburgh, Ph.D.; and Lorelei Fukuda, CTR.

The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 820 Jorie Blvd., Oak Brook, Illinois 60523-2251.

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Note: Copies of 1999 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Nov. 29.

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