Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women
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Assess the relationship between age and breast cancer-specific survival among older women and determine whether the observed age-related disparities in survival is explained by differences in breast cancer treatments received.
Women ≥65 years old at diagnosis with stage I–IIIA breast cancer diagnosed between 1997 and 1998 were recruited from four regions of the United States and followed prospectively for 5 years after diagnosis. Data was obtained from tumor registries, medical records, and telephone interviews. The primary endpoint was breast cancer-specific survival. Our independent variables were age operationalized as ≤75 years vs. >75 years, and receipt of recommended guideline therapy, adapted from the National Institutes of Health guideline consensus conference.
Of 689 women, 36% were >75 years. Women >75 years were less likely to have received the following; axillary lymph node dissection (84% vs. 93%, P = 0.0003), radiotherapy (40% vs. 54%, P = 0.0003), definitive primary therapy (71% vs. 84%, P < 0.0001), chemotherapy (9% vs. 28%, P < 0.0001), and guideline therapy (31% vs. 54%, P < 0.0001). The 5-year breast cancer-specific survival was 95% (95% confidence interval [CI], 90%, 97%) for those ≤75 years who received guideline therapy, 94% (95% CI, 90%, 97%) for those ≤75 years who did not receive guideline therapy, 96% (95% CI, 88%, 99%) for those >75 years who received guideline therapy and 83% (95% CI, 74%, 89%) for those >75 years who did not receive guideline therapy, (P = 0.002) by the log-rank test.
Receipt of guideline therapy may reduce the age-related disparity in breast cancer survival among older women.
KeywordsBreast cancer Older women Patterns␣of␣care Breast cancer-specific survival Undertreatment
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We thank Soe Soe Thwin of Boston University Medical Center, Department of Medicine, Section of Geriatrics, Boston, MA, for her valuable assistance in preparing data files for the project.
Supported by grants R01 CA/AG70818 from the National Cancer Institute and National Institute on Aging, R01 CA84506, K05 CA92395, CA093772-04S1 from the National Cancer Institute and an ASCO Foundation Young Investigator Award.
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