Age, not just comorbidity, affects breast cancer surgery rates in elderly

By Sarah Guy, medwireNews Reporter

The high rates of elderly UK women with breast cancer who do not undergo surgical treatment are not entirely explained by the presence of comorbidities, report UK researchers.

After adjusting data for 23,038 female breast cancer patients aged 65 years and above for Charlson score - indicating comorbidity status - increasing age predicted a lack of primary surgery among all women aged 70 years and over, found the team.

Indeed, surgery rates were significantly lower for this age group compared with their peers aged 65-69 years.

The result indicates a need for further research into age-bias in treatment access, say Katrina Lavelle (University of Manchester, UK) and co-workers in the British Journal of Cancer. They note that in 2007 only 39% of female breast cancer patients in the UK aged 80 years and over received surgery compared with 90% of those aged under 50 years.

The team examined two UK cancer registries linked with Hospital Episode Statistics data to assess comorbidities among women with invasive breast cancer. Mastectomy and breast-conserving surgery within 6 months of cancer diagnosis indicated treatment was primary surgery.

In all, 85.7% of the cohort had no comorbidities, while 10.0% had a Charlson score of 1 (where 0=no comorbidities and 7=severe comorbidity), and 4.3% had a score of 2 or higher.

Overall, 71.6% of women received primary surgery, with those aged between 65 and 69 years having the highest surgery rates, at 86.4%, and those aged 85 years and above having the lowest rates, at 34.1%.

Surgery rates also decreased with increasing Charlson scores, with 73.4% of women with no comorbidities (a score of 0) undergoing surgery, compared with 66.2% of those with a score of 1, and 49.1% of those with a score of 2 or higher.

In multivariate analysis, adjusted for the effect of comorbidity, women in the 70-74, 75-79, 80-84, and 85 years and above age groups were a respective 26%, 44%, 68%, and 87% less likely to undergo surgery than their counterparts aged 65-69 years.

"Prospective cohort studies are needed to examine the extent to which comorbidity and wider measures of health (such as frailty) as well as patient choice explain the lack of surgery for older breast cancer patients," suggest Lavelle and colleagues.

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