Source: DGNews  |  Posted 3 years ago

By Kristina Rebelo

SAN DIEGO -- April 14, 2008 -- Breast cancer in an elderly African-American population can be managed much the same as in a younger population, suggest data from a study presented here at the American Society of Breast Disease (ASBD) 32nd Annual Symposium.

The treatment of breast cancer in patients aged 80 years or more has largely been excluded from studies and clinical trials. Researchers at Washington Hospital Center, Washington D.C., therefore conducted a retrospective analysis of treatment administered to elderly African-American women with breast cancer at their institution.

Among 123 charts available for review, 126 total cancers were reported, 3 of which were bilateral cancers. The mean age of patients was 84 years (range, 80-100). Mean follow-up was 37.3 months.

The rate of overall mortality was 22%, and the overall complication rate was 12%. Postoperative seroma rate was 3%, postoperative haematoma rate was 0.01%, and deep vein thrombosis rate was 3%. No deaths due to therapy were reported.

Each patient had an average of 2.9 comorbidities (range 0-8). Thirteen percent of patients in the group were diagnosed at stage IV. Diagnosis was made by mammogram in 39% of cases, by palpable mass in 44% of patients, and unknown in 17%.

Surgical treatment included mastectomy in 35% of patients, partial mastectomy in 51%, and there was no surgery in 14% of patients. Axillary lymph node dissection was done in 35% of patients, lymph node biopsy in 21%, and no axillary surgery in 44%. Chemotherapy was administered to 8%, hormone therapy to 60%, and radiation therapy to 47%. Radiotherapy was given to 78% of patients with a partial mastectomy, and to 11% of patients who underwent full mastectomy.

Hypertension was the most common comorbidity in the study cohort (80%). Patients with another cancer at diagnosis made up 17% of the cohort; 8% of cases had a previous breast cancer diagnosis. Other cancers included vulvar, gastric, colon, cervical, and malignant fibrous histiocytoma.

"There is much literature in the area of undertreatment of the elderly," said poster presenter Lea Blackwell, MD, Breast Oncologist, Washington Hospital Center, Washington D.C. "There has been a lot of underutilisation of mammography. A large percentage of our patients had a palpable lesion that was ultimately found by themselves or a caretaker."

Dr. Blackwell said that those patients most likely to fall between the cracks in the medical system were those who suffered from cognitive dysfunction or dementia. She also noted that some studies have found that a degree of ageism may play a role in the undertreatment of these patients.

Breast cancer in an African-American elderly population can be managed similarly to that of younger patients appropriate for stage, the study researchers concluded. The treatment of the elderly population with breast cancer at Washington Hospital Center utilised standards of care that included partial mastectomy, sentinel lymph node biopsy, radiation, and hormonal therapy -- without significant complications. Chemotherapy was less likely to be used in this group.

"Once these women are identified, standard treatment is appropriate," Dr. Blackwell said April 10. "Their complications are no different than other, younger, populations. A prospective evaluation of multimodality therapy could further advance the treatment in this patient population."

[Presentation title: Breast Cancer Management in an African American Elderly Patient Population. Poster T22]