- The Washington Times - Thursday, March 3, 2005

Older women with breast cancer often are denied chemotherapy because of their age, but a review of medical literature reveals the treatment could improve survival for many older patients, who are most at risk for the disease and its return.

Age alone should not bar the use of chemotherapy in older women with breast cancer who are otherwise in good general health, a multicenter study published in this week’s issue of the Journal of the American Medical Association concludes.

“Older women and younger women derive similar reductions in breast cancer mortality and recurrence from regimens containing more chemotherapy,” said the study’s authors, led by Dr. Hyman B. Muss of the Vermont Cancer Center in Burlington.

However, older women also are the group hardest-hit by breast cancer.

“The incidence of breast cancer increases with increasing age, and almost half of all new breast cancer [cases] in the United States now occur in women 65 years of age or older,” Dr. Muss and his colleagues wrote.

At the start of their report, the investigators say it is already known that secondary treatment with chemotherapy in women ages 50 to 69 with early-stage breast cancer “significantly improves both relapse-free and overall survival.”

But they wanted to determine whether that treatment is “significantly underused in older patients” and whether the increased use of chemotherapy on older women elevates toxic effects in that age group.

In a review of four clinical trials to compare the benefits of more aggressive and less aggressive chemotherapy, the researchers say they were dismayed to discover that only 542 women, or 8 percent of the 6,487 women who participated in the trials, were 65 or older, and only 159 women, or 2 percent, were 70 or older. The investigators hailed from nearly a dozen medical institutions nationwide, including Georgetown University Medical Center.

The trial data involved women whose breast cancer had spread to the lymph nodes and had occurred between 1975 and 1999.

Both the report’s authors and two doctors wrote an accompanying editorial saying that as U.S. life expectancy continues to rise, “elderly patients can anticipate several additional years of life” by using chemotherapy.

“[H]ealthy women aged 65, 75, and 85 years can expect to live, on average, an additional 20, 12, and 6 years, respectively” with the help of chemotherapy, the editorial states.

The researchers also found that “smaller tumor size, fewer positive lymph nodes, more chemotherapy, and tamoxifen [a widely used breast cancer drug] were all significantly related to longer disease-free and overall survival” of those in the trials, who were monitored, on average, for 10 years.

“There was no association between age and disease-free survival. Overall, survival was significantly worse for patients 65 or older, because of deaths from causes other than breast cancer,” the authors say.

Nevertheless, a total of 33 deaths, or 0.5 percent, of all participating patients were attributed to treatment, and older patients had higher chemotherapy-related mortality than younger ones. For women younger than 50, the death rate from treatment was 0.2 percent; for those 51 to 64, 0.7 percent; and for those 65 or older, 1.5 percent.

Even so, more chemotherapy was associated with an overall hazard of death 18 percent lower than that for breast cancer patients receiving less chemotherapy. For women 50 or younger, the decrease was 17 percent; for those 51 to 64, 16 percent; and for those 65 or older, 27 percent.

Given those results, the researchers say “older patients with high-risk early breast cancer who are otherwise in good health” should be invited to participate in clinical trials designed to weigh chemotherapy’s remedial effects.

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