Interesting paragraph from this week’s Patients’ Association newsletter:
"Unequal breast cancer treatment for different ages
An audit published in the British Journal of Cancer commissioned by charity group Breakthrough Breast Cancer has revealed some startling differences in the way that breast cancer is treated across the country dependent on both location, and the age of the patients.
The audit compared 11 cancer treatment networks across the country and analysed 48,983 cancers. It found that older patients were less likely to undergo chemotherapy, radiotherapy or surgery compared with younger patients but were more likely to have full mastectomies compared to younger patients who had more breast conserving surgery.
Of the numerous statistics reported, the starkest contrasts were in chemotherapy treatment with 77% of patients under 50 receiving it compared with just 16% of over 50’s whilst only 31% of patients over 80 had radiotherapy compared to 78% under 50. In addition 48% of women over 50 had no surgery at all for their condition compared with 3.5% under 50. Regional differences were also present with respect to who received what type of treatment.
Breakthrough Breast Cancer said that older patients declining some of the treatments and surgery could explain for some, but not all, of the discrepancies. "
Hi Dahlia
I was diagnosed with a second primary tumour in 2004. (First was in 1993). I can recall the bcn telling me that I was ‘lucky’ (was there ever a more abused word in bc language?)to be under 50, because if I hadn’t have been, the chemotherapy side of my treatment would have probably been under threat.
This made me incredibly angry at the time - the average life expectancy for a woman in the UK is now over 80, yet little more than halfway there, you could find yourself in an NHS treatment ghetto…patched up well enough to go back to work for a few more years to pay plenty into a system that has already decided your life wasn’t worth the best treament they had available.
It stinks.
X
S
I was diagnosed in 2006 at 60 years age. I was advised that I would require a mastectomy as the tumour was presenting as two lumps. I was offered an immediate LD reconstruction (no implants). After the operation I was told that there was only one lump but shaped liked a barbell.
I was asked when I met the oncologist if I wished to take part in the TACT 2 trials which I did. After chemotherapy was finished I went on to have radiotherapy.
I must say that at no time was I made to feel that age was a consideration as to what treatment I would receive, and at no time did it even cross my mind that any difference would be made in age concerning treatment.
When I was having both chemotherapy and radiotherapy there were a lot of patients who were older than myself.
I would not like to think that patients were missing out on treatment because of age, with life expectancy increasing. There should be no regional differences either. My operation and treatment took place in central Scotland.
Love and take care
Thistle
Hi thistle - good to know that you had a positive experience.
The area where I was treated (don’t live there now, thank goodness) is well-known for being on the low side for cancer spending generally and for refusing applications for special funding for certain drugs - nearly all are turned down.
X
S
What does the report say about the differences in the kind of cancer which older and younger patients get? Older women are more likely to have er+ and pr+ and her2- breast cancer than younger women, also less likely to have grade 3 cancers than younger women.
Its not possible to make sense of these stats without knowing what kind of breast cancer participants in the study had. Personally, I was 54 at diagnosis and my doctors referred to me as a younger woman because my cancer (triple neg; grade 3) was typical of the presentation of many younger women. I have never felt my treatment has been affected by my age (though now I am 60 I am saying no to too much more treatment and may be doing this with a more philosophical attitude than I would if 20 years younger.)
Jane
Hi Ladies
I was told at the start that I would need chemo, radotherapy and hormone tratment, I’m 57 and at no point was my age considered an issue. Plus a lot of the ladies I see at clinic are of various ages.
However what I have noticed from reading posts both on here and other sites is that how well one is treated does seam to be where you are treated. I was very aprehensive about this but think I’m probaly at a center of excallance, also have the best GP practice going for which I am extreamely grateful, but it makes me sad and angry that not everyone gets such good care when it should be a right.
g
I was dx with triple neg grade 2,2cm IDC at the age of 62.There was no spread to nodes and no vasc invasion.I was given a WLE followed by chemo[fecx4taxoterex4]and 15 rads.Now 65.
Hi
I am 52, was ER++ but HER2 neg, node negative. Was told I would be advised to have chemo if HER2 +ve but only rads if not. I think at our centre it’s all worked out statistically and if there’s only a couple of per cent benefit from having chemo they don’t offer it.
It is shocking that bc treatment can be a postcode ‘lottery’ if that’s the case however. Every woman has a right to the best possible treatment regardless of age or postcode.
alex
xx
interesting reading ! I am curious about all this - it seems that tiny differences seem to put you in different slots -I’m wondering a lot about my treatment, which I am happy with I think, but am not sure how it’s all worked out. I was dx with 2.4 cm idc grade 2 and intermediate dcis, er+ , snb but nodes clear, no vascular invasion, WLE and rads and tamoxifen advised. Apparently no testing for HER2-I’m thinking that maybe they thought it unlikely I should be HER2+ being just 50 and having a grade 2 tumour - 0bviously average and not aggressive.
I was diagnosed at 65 and at no time have I felt that I have had anything but the best and most thorough treatment.
I have not been happy with some of it- especially the chemo dept where I was treated but after rapid referral had WLE & SNB followed by full axillary clearance, 3x FEC, 3 xTax and 15 rads. I am now on Arimidex & feel I have had the full belt and braces treatment.
Maybe I have just been lucky - or maybe it helped being stroppy!
Diagnosed last year at 58, triple neg, grade 3, lymph node involvement, I can only say I was given every treatment necessary.
The only time my age was mentioned, was when I asked about a DIEP recon. The surgeon said it was too long an op for someone of my age, (I had a bilateral mast).
I happily accepted this and agreed in principal to an LD.
Shortly after I moved to another part of the country, saw a new surgeon this week who said,no way would she do a LD on BC side, only a DIEP.
Happy to do LD on non cancer side.
My mind boggles on the conflicting opinions!!!
Kathy
Call me an old cynic (:-)), Kathy, but my ‘read between the lines’ mind would immediately convert ‘too long for someone my age’ as meaning ‘we don’t spend that kind of money on older people’.
People far older than you undergo major surgery in long operations. Yes, their recovery time may be longer and more complicated (perhaps the cost issue is here, in post-operative care?), but this really shouldn’t be an issue - or, at least, THE issue. Overall state of health should at least be taken into account. And Kathy, you aren’t old!
I think I have a broader outlook on treatment as I’ve been through the lump/biopsy/op/treatment mill more than once. I don’t think I necessarily got the best or most up-to-date treatment possible on either occasion, but presumably the best the NHS could manage or afford at time. Come to think of it, I really didn’t have any other options, did I?
X
S
I work in the NHS where we make decisions on treatment all the time - not breast cancer, but oral cancer and other serious oral diseases. Age on its own is never an issue in terms of cost. Sometimes aggressive treatment is not in the patient’s best interest if their general state of health is not good, regardless of age. Often (not always) older people have less aggressive cancers than those who are younger so don’t need a belt and braces approach. So many factors have to be taken into consideration when deciding a treatment plan and the patient should always be involved with this. One of my patients is in her eighties and just had an extensive course of treatment with me as we both felt it was right for her.
If you want to read the original press release, it is here: Breakthrough Breast Cancer audit reveals striking differences in breast cancer treatment based on age. The full report is available as well from them.
One item in the original posting needs correction: In addition 48% of women over 80 (not 50 as in original post) had no surgery at all for their condition compared with 3.5% under 50.
This must vary because I can honestly say that where I have been treated there seems to be no ageism. I have known people in their 70s and 80s getting chemo. but at the same time an uncle of mine who was operated on at the same time as me in feb 08 for bowel cancer did not receive chemo and the cancer had apparently spread to his lymph nodes. He lived another 15 months. He was in very poor health though and I wouldnt have thought he could have taken chemo. As has been said I think overall general health is taken into account certainly this is the case with Herceptin. But I also know of people in the 70s getting that as well.