Frequency of axillary node dissection and chemotherapy in breast cancer patients over 60 years of age compared with those younger than 60 years of age

Abstract

8161 Background: Axillary lymph node dissection (ALND) is used to stage breast cancer (BRCA) patients and to select appropriate adjuvant therapy. Older patients may not be offered ALND under the assumption they would not be candidates for chemotherapy. As a result, many patients over age 60 may be undertreated and have an increased risk of BRCA recurrence. The purpose of this study is to compare the rate of chemotherapy and ALND in patients older than 60 years with patients younger than 60 years. Methods: Retrospective chart review of invasive BRCA patients referred for adjuvant treatment at a single academic centre between January 1999 and March 2001. Demographic information, tumour characteristics, surgical and chemotherapy treatment data were collected. Co-morbidity was documented using the Charlson score which assigns 1–2 points for conditions including diabetes, angina, and vascular disease. Results: 293 patients less than 79 years of age were identified. In 166 patients under 60 years, 93.4% received node dissections, 69.3% received chemotherapy and 3.6% declined chemotherapy. However, of 127 patients between 60 and 79 years, 61.5% received axillary dissections, 29.1% received chemotherapy, and 9.5% declined chemotherapy. Average co-morbidity scores for patients less than 60 were 0.14, while those above 60 were slightly higher at 0.54. 7.2% of patients below age 60 had co-morbidities, in comparison 31.5% of those 60–79 had co-morbidities. Of those over 60 years with co-morbidity, the majority had only 1–2 health problems (80%). Tumour size (21 mm vs. 18 mm) and number of lymph nodes in those with ALND (1.1 vs. 0.8) were similar between groups. Conclusions: Although women aged 60–79 did not have a heavy burden of co-morbid illness; they were less likely to receive ALND or chemotherapy. Treatment decisions may be influenced by age rather than by co-morbid status or patient preference in those aged 60–79 who may otherwise be candidates for more aggressive treatment. No significant financial relationships to disclose.