Treatment of elderly, breast cancer patients in a community hospital setting

Hypothesis: Elderly breast cancer patients are underdiagnosed and undertreated in a community hospital setting. Design: Retrospective study of tumor registry patients. Setting: Community hospital. Patients: A total of 354 breast cancer patients aged 70 years or older diagnosed between 1992 and 2002 were identified from the tumor registry. The data for 3 prospectively chosen age subgroups (aged 70-74, 75-79, and >= 80 years) were subsequently analyzed. Main Outcome Measures: Data were collected regarding the method of detection of cancer, tumor characteristics and staging, type of treatment, and patient comorbidities. Comparisons between age subgroups were made using a likelihood ratio chi(2) test. Results: Forty-six percent of all patients presented with palpable breast cancer. Mammography was frequently used as an adjunct to the physical examination but was helpful in detecting occult disease in only 54% of all patients and 38% of patients older than 80 years. Although more than 70% of patients were considered stage I or II, complete pathologic staging was only performed in 64% of patients. Approximately 50% of patients were treated with breast-conservation surgery; however, adjuvant radiation therapy was omitted in 55% of these patients. Additionally, only 29% of patients with positive lymph nodes received chemotherapy, and 67% patients who were estrogen receptor-positive received adjuvant hormonal therapy. Conclusions: Older breast cancer patients are more likely to be diagnosed and staged clinically. Mammography is underused as a screening modality. While breast-conservation surgery was performed in about half of the patients, adjuvant radiation, chemotherapy, and hormonal therapies were frequently excluded.