Non standard management of older women with breast cancer in the UK

Women aged ≥70 years experience highest incidence and worse relative survival for breast cancer in England. Substantial differences in treatment by age have been demonstrated but may not be generalisable to the UK due to differences in survival and health care systems. Practice guidelines indicate that management may justifiably differ on the basis of the patients’ tumour characteristics and fitness. We investigated whether the disparity in treatment for breast cancer by age persists once differences in these variables are adjusted for in a UK based population. We undertook:(1) a retrospective case note review of women aged ≥;65 years, resident in Greater Manchester with invasive breast cancer registered in 1999 (n = 480) adjusting for differences in tumour characteristics(2) a prospective study of patients diagnosed in 2002-3 (n = 76) adjusting for co-morbidity and general health (represented by Activities of Daily Living)Study 1: Older women were less likely to receive standard management compared to younger women for all indicators investigated. Compared to women aged 65-69 years, women aged ≥80 years with operable (stage 1-3a) breast cancer had increased odds of not receiving triple assessment (OR = 5.5, 95% CI: 2.1-14.5), not receiving primary surgery (OR = 43.0, 95% CI: 9.7-191.3), not undergoing axillary node surgery (OR = 27.6, 95% CI: 5.6-135.9) and not undergoing tests for steroid receptors (OR = 3.0, 95% CI: 1.7-5.5). Study 2: The odds of patients aged ≥80 years with operable breast cancer undergoing surgery were reduced by a factor of 44 (OR: 0.023, 95% CI: 0.001-0.361) compared to patients aged 65-79 years.These results demonstrate that older women in the UK are less likely to receive standard management for breast cancer, compared to younger women and this disparity is not explained by differences in tumour characteristics and general health.