Swiss researchers report that many elderly women with breast cancer appear to have died because they did not receive full or appropriate treatment for their disease. Their study, published in the Journal of Clinical Oncology (Vol.21, No. 19: 3580-3587), reported that breast cancer patients over age 80 who did not receive adequate treatment had a much higher death rate from their cancer than women who did receive proper treatment.

Although we are often struck by the tragedy of young women developing breast cancer, this disease is actually more common in older women. Twenty-two percent of women diagnosed with this cancer in the United States are over age 75.

Many of these women have other illnesses -- high blood pressure, diabetes, or arthritis, for instance -- that may or may not be life-threatening. Because of this, sometimes doctors or the patients themselves are reluctant to consider appropriate cancer treatment, which includes surgery, radiation and drug treatment (chemotherapy).

The Swiss researchers examined the records of 407 women diagnosed with breast cancer who were 80 or older. About half were undertreated. They either did not have any surgery, or had lumpectomy without post-operative radiation.

The researchers could not determine why these women did not receive adequate treatment. One possibility is that the doctors thought the women were too sick to benefit from treatment, or more likely to die of another disease first. The patients themselves may have believed this, too; 14% of them refused some or all of the recommended treatment.

Doctors and patients also may have thought that breast cancer in the elderly is somehow less dangerous than it is in younger women, though that is not necessarily true.

When the researchers examined the survival patterns of these women, they found that less therapy meant a quicker death from breast cancer. The researchers specifically looked at women who died of their breast cancer.

Women who received complete therapy, including surgery and extra treatments such as radiation or drug therapy, had a five-year survival of around 90%. Those receiving no treatment had a five-year survival of around 46%. Women who were given some treatment such as surgery without any additional therapy had survival rates that were between these extremes.

Some doctors or patients are reluctant to consider surgery and instead try to get by using tamoxifen only, because it is noninvasive and easy to administer. Although tamoxifen is an effective anti-breast cancer drug, it is no substitute for surgery. Several studies have shown that the cancer will eventually grow and spread if a tumor isn't first removed surgically, even if the patient continues to take the drug.

The authors point out that the problem of undertreatment may stem from a belief that elderly patients do not tolerate treatment. But they cite several studies that show that these patients tolerate chemotherapy and radiation as well as younger women.

The researchers say doctors need to consider each woman's general health, then provide treatments that "offer the best chance of cure, regardless of age."