Section 1
Breast Cancer in the elderly

AGE BIAS IN CLINICAL DECISION-MAKING

A lot of physicians in practice have age biases, including oncologists. But the data demonstrate that older women in relatively good health tolerate things like chemotherapy, surgery and radiation therapy as well as their younger counterparts. There’s also good data from the Overview 1, for instance, that adjuvant tamoxifen in ER-positive patients over age 70 not only lowers the relapse rate but significantly improves survival.

There is, unfortunately, little prospective data concerning adjuvant chemotherapy in women over age 70. But from limited data — including some new,unpublished findings from the Overview with about 1,000 women over age 70 in randomized trials of chemotherapy — older women seem to have the same proportional risk reduction in relapse as other postmenopausal women. So, for selected patients — for example, those with very large primary lesions or positive nodes who are in otherwise good health — chemotherapy is worthy of consideration, and we need to develop trials focusing on older women. We’re slowly getting there, but I suspect in the mindset of many medical oncologists there’s still a reluctance to be aggressive with older women.

—Hyman Muss, MD

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