Older breast cancer patients receive poorer care
April 2007Researchers led by the School of Nursing, Midwifery and Social Work have found that older women with breast cancer get a lower level of care than younger women.
A retrospective case note review in the British Journal of Cancer found that they are less likely to be diagnosed via needle biopsy and triple assessment, undergo surgery or receive radiotherapy than younger women.
Dr Katrina Lavelle explained: "We found that women aged 70+ are less likely to receive the same care as younger women, and that this is related to their age rather than differences in the biology of their tumour." In England the highest incidence of breast cancer occurs in women aged 70 and older.
The review, based on the North Western Cancer Registry database of women aged 65+ in Greater Manchester, found that older women also experience the worst survival rates: 61% for those aged 80+ compared to 80% for all ages. This rate falls beyond what might be expected due to their increased age.
Compared with a 65-69 year-old, a woman aged 80 or older is five and a half times less likely to receive triple assessment for operable breast cancer and 40 times less likely to undergo surgery. Even women as young as 70-74 are over seven times less likely to receive radiotherapy following breast conservation surgery.
The team also discovered that the percentage of women in all age groups not receiving steroid receptor tests, which indicate suitability for hormone therapy, was high at 41%; meaning treatment decisions are being made without this information. Yet three quarters of the patients not tested were given the hormone therapy tamoxifen - without evidence that it would work.
In a 2004 survey 75% of UK breast cancer surgeons reported that they would treat older breast cancer patients similarly to younger patients, and 98% that the cut off point for surgery was not age related.
Katrina says: "Clearly there is a difference in clinicians' perceptions and their actual practice; standard management of breast cancer was infrequent in older women in Greater Manchester. The lack of diagnostic and steroid receptor testing resulted in older cancer patients having no effective treatment, with 41% not undergoing a steroid receptor test - 32% of whom received tamoxifen as their sole form of treatment.
"Mortality of elderly breast cancer patients is unlikely to improve where this pattern of management persists."
School research lead Professor Chris Todd commented: "It would be wrong to conclude that ageism is to be found in the NHS on the basis of these results alone, as this study has not been able to take the preferences of older women themselves into account. This is something we intend to investigate in the next phase of our research."
