MEMORANDUM FOR: Science Writers and Editors on the Journal Press List

Breast Cancer Diagnosed in Older Women Is Often Less Aggressive

March 30, 2000 (EMBARGOED FOR RELEASE 4 P.M. EST April 4)

Katherine Arnold, Deputy News Editor, Dan Eckstein, (301) 986-1891, ext. 112

Women aged 70 years or older with breast cancer that has not spread to the lymph nodes live, on average, as long as women of the same age without breast cancer.

Although the number of elderly patients with breast cancer is increasing, little is known about possible differences in the biology and clinical outcomes of breast cancer according to age. Therefore, Sami Diab, M.D., at the Rocky Mountain Cancer Centers, Aurora, Colo., and colleagues at the Baylor College of Medicine, Houston, Texas, analyzed data on older women with invasive breast cancer. They present their findings in the April 5 issue of the Journal of the National Cancer Institute.

The study population was derived from 50,828 patients in San Antonio breast cancer databases and 256,287 patients in the Surveillance, Epidemiology, and End Results (SEER1) registry. Tumor biologic and clinical characteristics, local and systemic therapies, and survival according to the patient’s age were analyzed. Survival was also compared with that of age-matched women from the general population.

The authors report an association between increasing age at diagnosis and the presence of more favorable biologic characteristics of the tumor, including more tumors that have steroid receptors, lower growth rates, normal number of chromosomes, normal p53, and absence of the expression of epidermal growth factor receptor and c-erbB2. These characteristics are markers of more aggressive tumors.

In older patients with lymph node-negative disease and/or small tumors, the observed and expected survivals were almost identical. In the SEER registry, for example, the 8-year survival of lymph node-negative patients relative to the expected survival of age-matched women from the general population was 1.01 for patients 70–74 years old, 1.06 for patients 75–79 years old, and 1.09 for patients 80–84 years old. Breast cancer was responsible for 73% of all causes of death in breast cancer patients between the ages of 50 and 54 years. This percentage gradually decreased as age increased, with breast cancer being responsible for only 29% of all deaths in patients 85 years old or older. This relative decrease in breast cancer-related mortality was even more pronounced in patients with small tumors, where breast cancer was responsible for only 12%–16% of all deaths in patients 75 years old or older.

Both local and systemic therapies for breast cancer differed according to age, with older women receiving less therapy. In the San Antonio databases, there was a gradual decrease in the number of patients receiving systemic chemotherapy according to age, with 30%, 16%, 6%, and 1% of patients 55–64 years old, 65–74 years old, 75–84 years old, and 85 years old or older, respectively, receiving such therapy. On the other hand, adjuvant endocrine therapy was prescribed almost equally (36%–38%) in all age groups.

The authors note that the majority of clinical trials that have addressed various therapies for breast cancer have not included older patients and that definitive recommendations from these studies might not apply to older patients. Therefore, the authors conclude that the best approaches to therapies in elderly patients require evaluation in clinical trials.

1SEER is a set of geographically defined, population-based, central cancer registries in the United States, operated by local nonprofit organizations under contract to the National Cancer Institute (NCI). Registry data are submitted electronically without personal identifiers to the NCI on a biannual basis, and the NCI makes the data available to the public for scientific research.

Contact: Brad Bawmann, Rocky Mountain Cancer Centers, (303) 320-7790; fax: (303) 320-7661.

Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.



             
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