Breast Cancer Treatment Effectiveness in Older Women

Background

Breast cancer is a disease primarily of older women. The incidence of breast cancer reaches its maximum in the ninth decade of life. It is a serious disease in older women. Care of older women is further complicated by the fact that age is not only a major risk factor for breast cancer, but also for an increased burden of co-morbid disease and functional disability. This burden, coupled with uncertainty as to what represents appropriate therapy, makes the care of this expanding population of new cancer patients a major challenge for clinicians.

Study Aims

This project has four primary objectives:

1. Compare the effectiveness of standard primary tumor therapy (breast conserving surgery, axillary dissection, and radiation therapy or modified radical mastectomy) versus other than standard therapy in preventing breast cancer recurrences and mortality, adjusting for comorbidity, tumor characteristics, geographic site, and demographic characteristics.
2. Determine the extent to which the addition of systemic adjuvant therapy (chemotherapy, hormonal therapy, or the combination of chemotherapy and hormonal therapy) modifies the effectiveness of standard and other than standard primary tumor therapy in preventing breast cancer recurrences and mortality.
3. Describe patterns of surveillance testing for breast cancer recurrence and determine the extent to which surveillance testing is associated with a reduction in breast cancer-specific mortality.
4. Identify provider, tumor, and patient characteristics associated with the receipt of standard primary tumor therapy and systemic adjuvant therapy in older women with newly diagnosed early stage disease in the HMO setting.

Methods

Using a historical cohort design, six sites from throughout the United States will together identify and follow 2,750 women for 10 years. Both electronic and medical record data sources will be used to collect information that will allow us to characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer recurrence and mortality.

Significance

An estimated 192,000 women were diagnosed with breast cancer in 2001, with 53 percent occurring in women 60 years of age and older. This proportion and corresponding absolute numbers are likely to grow, because older age is the most important risk factor for breast cancer, and because gains in life expectancy will result in more women at risk for longer periods of time. This project fill an important gap in knowledge by providing evidence regarding the effectiveness of breast cancer treatments in older women.

Project Status

This project was funded in 2003 as an R01 (Research Project), and is closely affiliated with the CRN. Rebecca A. Silliman, MD, PhD, of Boston University, is the principal investigator. Data collection is underway.

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