Researchers found that doctors generally exclude patients over the age of 75 from intense chemotherapy because they are perceived to be too frail to handle the side effects. This age bias is likely due to doctors' misconceptions about the ability of older patients to handle aggressive treatment because of illnesses and conditions associated with age, and incorrect assumptions about the aggressiveness of their disease.
In a study of 2,999 women over the age of 50 who had invasive breast cancer, researchers evaluated each patient's disease, as well as the patient's treatment options. While the use of surgery was similar among the different age groupsâages 50-64, ages 65-75, and older than 75âthe use of other treatments differed.
In women who had surgery to conserve their breast, radiation therapy was not offered to 46.3% of patients over age 75, compared with 15.5% of women ages 65-75, and 14.4% of patients ages 50-64. Chemotherapy was offered to only 6.4% of patients over the age of 75, compared with 35.4% of the other two groups.
Giuseppe Curigliano, MD, the study's lead investigator, credited these differences to the widespread, though incorrect, impression that breast cancer is aggressive in younger women but not aggressive among older women. However, just the opposite is true.
Women over the age of 75 were more likely to have cancer that could spread: 62% had lymph nodes that contained cancer cells, compared with 52% of women in the 65-75 age group and 51% of women aged 50-64.
In another study looking at the use of adjuvant chemotherapy in the older population, researchers from the Cancer and Leukemia Group B (CALGB), one of the National Cancer Cooperative Groups, found that adjuvant chemotherapy is just as effective in treating older women with breast cancer that has spread to the lymph nodes as it is in treating younger women. Adjuvant chemotherapy is chemotherapy that's given in addition to the primary treatment, such as surgery, to improve the chances of curing cancer.
"In general, healthy older people can tolerate treatment as well as younger patients," said Hyman B. Muss, MD, of the University of Vermont, and the study's lead investigator. In this study of nearly 6,500 patients, age was shown to have no effect on breast cancer survival.
Researchers also found that older women are underrepresented in clinical trials of breast cancer treatments. Among the study group, only 8% of patients were 65 or older and only 2% were 70 or older.
Many doctors simply are not aware of the benefits of chemotherapy treatment for older patients, Dr. Muss explained. The low number of older women who participate in clinical trials reflects many doctors' misconception that older patients may not be able to tolerate the more intense chemotherapies that are often studied in clinical trials.
What Does This Mean For Patients?
"It is more the general condition of the patient, rather than age, that should be dealt with when treatment options are being considered," said Dr. Curigliano. One of the best ways to ensure that you or a loved one is getting the best quality of care is to truly understand your diagnosis and treatment. Dr. Muss recommends that older women, in particular, ask the following questions when facing a breast cancer diagnosis:
- What are the benefits of chemotherapy and/or hormone therapy for my tumor?
- How will my quality of life be affected if I am treated for breast cancer with chemotherapy?
- Are there any open clinical trials that fit my needs?
- Am I eligible for any clinical trials?
Breast Cancer 
Clinical Trials