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Age Bias Undermines Treatment of Breast Cancer

Mon September 1, 2003 02:58 PM ET

By Megan Rauscher

NEW YORK (Reuters Health) - Older women with breast cancer are being
denied lifesaving treatment for breast cancer solely because of their
age, results of a study of some 480 women suggest.

In the study, women over age 50 with early stage breast cancer were
significantly less likely to be given "adjuvant" chemotherapy -- that
is, in addition to surgery and other treatments -- researchers from Ohio
State University in Columbus report in the journal Cancer.

The finding fuels the belief that age bias contributes to undertreatment
of older women with breast cancer.

A number of past studies have already shown that older women are less
likely to be treated with adjuvant chemotherapy, Dr. Charles L. Shapiro
and colleagues say. But until now it hasn't been clear what impact a
woman's age has on the decision to use or withhold adjuvant
chemotherapy.

They theorized that taking into account "all of the relevant factors"
that go into the decision to use chemotherapy -- including the size of
the tumor, whether it responds to anti-estrogen therapy or not, whether
the disease has spread to the lymph nodes, and underlying health
problems -- older age would be a less important factor in the decision
to use adjuvant chemotherapy.

"To our surprise, we found the opposite was true," Shapiro told Reuters
Health. "Controlling for all the relevant factors, older age becomes a
more important factor, with older women less likely to get
chemotherapy," he said.

Women older than 65 with tumors that do not respond to estrogen,
so-called ER-negative tumors, were about seven times less likely to be
treated with chemotherapy than women younger than 50. This worries
Shapiro, because these women do not benefit from estrogen therapy. "For
them, chemotherapy is the only option," he said.

Women with ER-positive breast cancers between the ages of 50 and 65 were
six times less likely to be offered chemotherapy and those over 65 were
62 times less likely to receive it than women younger than 50.

"Over the next 25 years, doctors and women will increasingly face this
decision, as the population of early stage breast cancer patients over
age 65 will increase," Shapiro told Reuters Health.

"Hopefully, this work will stimulate larger studies that examine the
attitudes and preferences of older women and their physicians with
respect to the use of adjuvant chemotherapy," he added.

SOURCE: Cancer, September 15, 2003.

http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=3368900&src=eDialog/GetContent&section=news