Age is a well documented factor that may lead to disparities in screening, diagnosis, and treatment. Mammography screening, which typically begins at age 40 or later, has been a somewhat problematic early detection tool for younger women, whose breast tissue is often denser than that of older women. The incidence rate in very young women is so low that breast lumps and nipple discharges may not be properly evaluated, leading to later diagnoses. The combination of delayed diagnoses with typically more aggressive, estrogen receptor-negative disease can be a deadly one.
Elderly patients, like very young patients, have also suffered from inferior care, and have often failed to benefit from treatment innovations. Clinical trials have historically provided little information on women older than 65, and surgeons and medical and radiation oncologists have in the past tended to undertreat such patients, even in the absence of co-morbid conditions, in order to spare them from the rigors of radiation, chemotherapy, and axillary dissection. Recently, however, a number of studies have demonstrated that healthy older women with high-risk breast cancers can benefit as much as younger patients from combination chemotherapy, radiation and other treatments.
“More than half of all new breast cancers in the United States occur in women 65 years old or older, a statistic that has even more impact in a population whose longevity is increasing,” writes Hyman Muss, in his review of the impact of age, race, and socio-economic status on the selection of adjuvant therapy in breast cancer.39 Because of a higher incidence of other health concerns, older women are less likely to be offered chemotherapy and radiation, and they are less likely to participate in clinical trials. The lack of trials information in elderly women about the effects of adjuvant treatment on quality of life and survival must be remedied.