Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

BACKGROUND The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received. METHODS A stratified random sample was selected among women age ≥ 50 newly diagnosed with lymph node negative breast carcinoma in Québec in 1988, 1991, and 1993. Information was ed from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast‐conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple logistic regression analysis. RESULTS Overall, 1174 patients age ≥ 50 years with breast carcinoma were included. Women age ≥ 70 years were much less likely to receive definitive locoregional treatment compared with women ages 50–69 years (48.7% vs. 83.5%; P < 0.0001). Older women were less likely to undergo surgery with breast preservation (76.7% vs. 86.3%; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 64.7%; P = 0.41). Adjusting for comorbidity and other characteristics related to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12–0.18 for women age ≥ 70 years vs. women ages 50–69 years). The same association was observed when women who did not undergo lymph node dissection but who received systemic adjuvant treatment were considered to have received definitive therapy (OR, 0.13; 95% CI, 0.10–0.17) for women age ≥ 70 years vs. women ages 50–69 years). CONCLUSIONS Less aggressive patterns of care are provided to elderly breast carcinoma patients, independent of comorbidity. This could explain, at least in part, the sustained breast carcinoma mortality in this population. Cancer 1999;85:1104–13. © 1999 American Cancer Society. A population‐based study of women newly diagnosed with lymph node negative breast carcinoma in Québec showed that elderly patients (age ≥ 70 years) are less likely to receive definitive treatment, even after adjusting for comorbidity and characteristics of their disease, the attending physician, and the treatment center.