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Surgery Best for Controlling Breast Cancer in
Elderly Women
By
Becky Ham, Science Writer
Health Behavior News Service
Jan. 30, 2006 - Although women over age 70 are
rarely offered surgery to treat their breast cancer, a new review of
recent studies suggests surgery works better than hormone therapy to
stop the progression of breast cancer in older women with operable
tumors.
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Although there was no significant difference in how
long the women lived after having either surgery or first-line hormone
therapy such as tamoxifen only, two of the studies found that women can
go longer without their breast cancer becoming worse if they have
surgery.
In fact, older women who had surgery alone or
surgery combined with hormone therapy were half as likely to see their
cancer progress over the course of the study as those who opted for
hormone therapy only, say Daniel Hind of the University of Sheffield in
England and colleagues.
Surgery controls breast cancer better than
tamoxifen alone in women aged 70 years and over but does not extend
survival, the researchers concluded.
The review appears in the current issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
Hind and colleagues examined seven studies of 1,571
women age 70 and older who had operable breast cancer, or cancers where
the main tumor was mostly limited to breast tissue with little spread to
other parts of the body. Study lengths ranged from three years to 12
years.
The studies included tumors that were sensitive and
insensitive to estrogen receptor therapy, the primary drug treatment for
breast cancer. Tamoxifen, the primary hormone treatment in all of the
studies, blocks the activity of estrogen in the body.
Hind acknowledged that results could have been
different if estrogen-insensitive tumors had been excluded from the
review. However, it is unlikely that the considerable local control
advantage conferred by surgery would be overcome, he said.
While younger women with breast cancer often get
hormone therapy in addition to surgery, women over 70 are usually
prescribed tamoxifen only, based on the premise that older patients are
less likely to be fit for surgery, Hind said.
On average, the hormone therapy tamoxifen shrinks
or slows the growth of tumors for only 18 months to 24 months. This
could leave elderly patients even older when they need to turn to other
hormonal therapies or surgical options.
Newer breast cancer drugs such as Femara and
Arimidex, which lower the amount of estrogen produced by the body, may
be useful treatments for older women who are unfit for surgery, but more
rigorous testing of the therapies is needed, Hind and colleagues
conclude.
Other studies suggest a bias against surgery in
older patients that may not be warranted by the data. Several recent
studies suggest elderly people are not treated as aggressively as their
younger counterparts, although many of them respond well to
more-invasive treatment.
Denise Uyar, M.D., a professor of obstetrics and
gynecology at the Medical College of Wisconsin in Milwaukee, recently
completed a study that found elderly women were less likely to have
surgery or certain types of chemotherapy for ovarian cancer, although
they were often suitable candidates for these treatments.
However, it is difficult to determine ones
fitness for undergoing intensive treatment for cancer whether it is
surgery or chemotherapy, Uyar says.
The elderly are an increasingly diverse population
and unfortunately there is no single assessment tool able to identify
patients who are not only elderly, but frail, and at risk of dying from
treatment complications, she adds.
The study was supported by the North Trent Cancer
Research Network, UK.
Hind D, et al. Surgery versus primary endocrine
therapy for operable primary breast cancer in elderly women (70 years
plus). The Cochrane Database of Systematic Reviews 2006, Issue 1.
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit http://www.cochrane.org for more information.
Supporting Documents
Surgery Versus Primary Endocrine Therapy for Operable Primary Breast
Cancer in Elderly Women (70 Years Plus)
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