• Forschung [+]
  • Thomas Heckmann

Results from a Population-Based Database in Sweden

Differences in Management of Older Women Influence Breast Cancer Survival

© Erich Westendarp / pixelio.de
© Erich Westendarp / pixelio.de

Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.

Abstract

Background

Several reports have shown that less aggressive patterns of diagnostic activity and care are provided to elderly breast carcinoma patients. We sought to investigate whether differences in the management of older women with breast cancer are associated with survival.

Methods and Findings

In an observational study using a population-based clinical breast cancer register of one health-care region in Sweden, we identified 9,059 women aged 50–84 y diagnosed with primary breast cancer between 1992 and 2002. The 5-y relative survival ratio was estimated for patients classified by age group, diagnostic activity, tumor characteristics, and treatment. The 5-y relative survival for breast cancer patients was lower (up to 13%) in women 70–84 y of age compared to women aged 50–69 y, and the difference was most pronounced in stage IIB–III and in the unstaged. Significant differences in disease management were found, as older women had larger tumors, had fewer nodes examined, and did not receive treatment by radiotherapy or by chemotherapy as often as the younger women. Adjustment for diagnostic activity, tumor characteristics, and treatment diminished the relative excess mortality in stages III and in the unstaged, whereas the excess mortality was only marginally affected in stage IIB.

Conclusions

Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.

 

Citation: Eaker S, Dickman PW, Bergkvist L, Holmberg L, The Uppsala/Örebro Breast Cancer Group (2006) Differences in Management of Older Women Influence Breast Cancer Survival: Results from a Population-Based Database in Sweden. PLoS Med 3(3): e25. doi:10.1371/journal.pmed.0030025

Academic Editor: Eduardo Franco, McGill University, Canada

Received: May 26, 2005; Accepted: October 31, 2005; Published: January 17, 2006

Copyright: © 2006 Eaker et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: BCS, breast-conserving surgery; CI, confidence interval; ER−, estrogen receptor–negative breast cancer; ER+, estrogen receptor–positive breast cancer; N0, negative lymph node involvement; N1, positive lymph node involvement; RER, relative excess rate; RSR, relative survival ratio.

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