Elderly patients being cared for in community hospitals may be under-diagnosed and under-treated, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals. For the study, researchers identified 354 women aged 70 or older who were diagnosed with breast cancer between 1992 and 2002 at a community hospital. The group was divided by age groups: 70 to 74, 75 to 79, and 80 or older.
Overall, 46 percent of the patients came to their physician with breast cancer that could be felt during a physical examination. And while most of the women did have mammograms, they were mainly used to verify the results of the physical exam. Mammograms were able to uncover previously undetected breast cancer in just 54 percent of the patients. More than 70 percent of patients were in the early stages of cancer. Evaluation of the lymph nodes to assess thoroughly the cancer's progression was omitted in 36 percent of the cases, and 56 percent of those in women 80 or older, according to the study.
The study also found that about half of the women received breast-conserving surgery. But the rates of chemotherapy, radiation, and hormonal therapy were lower than would be expected and were lowest in the oldest women included in the group evaluated.
"We also noted omissions of treatment in patients with indications for adjuvant [combination] treatment," which includes patients whose cancer had reached their lymph nodes or those with estrogen receptor-positive tumors, the study’s authors indicated.