Many Older Women With Breast Cancer Dont Die From It
There are more deaths from breast cancer in older women simply because most diagnoses occur in older women, but most of these women will die from a cause other than their breast cancer. Breast cancer survival rates, for women of any age, depend on the cancers stage and subtype.
Any woman, regardless of age, who has a family history of cancer, particularly breast and ovarian, should bring it to the attention of her physician, who can evaluate potential breast cancer risk, the need for genetic testing, and the proper screening plan to follow.
Life Is Prolonged Cancers Increase
In Finland, already more than 32 000 new cancers were found in 2013. The amount is threefold compared to the incidence rates in the 1970s. The main reason for the increase in the incidence of cancer is that people live longer than before.
A persons average lifespan has continuously extended. Life expectancy is most affected by deaths in childhood or during working age. In particular decreases in infant mortality extend the life expectancy of the entire population. In Finland, the health of the population began to improve rapidly after the war, as education and income increased.
The life expectancy for Finnish men is currently 79 years and for women 84 years. The maximum age in humans is thought to be between 115 and 125 years.
Many of the elderly are independent and in good condition, and have an active life. Falling ill with cancer is a shocking experience regardless of age, and most of the elderly wish for active treatment, if such is available.
The most common cancers in older men are prostate, lung, and gastrointestinal cancers. The most common cancers in older women are breast, gastrointestinal, lung, and gynecological cancers.
Figure 2. Trends in cancer mortality in persons aged 75 or older in 19542013.
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Breast Cancer Treatment In Those Over 70 Can Be Reduced
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This video features the investigators discussing their study.
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Role Of Postoperative Rt
Postoperative RT following breast-conserving surgery, combined with appropriate systemic adjuvant treatment, has been shown to significantly reduce both absolute risk for 5-year recurrence and 15-year absolute breast cancer mortality risk. Proportional reductions were found in all patients regardless of age, although absolute risk was lower in older patients.18
No significant increase in RT toxicity has been seen in older women. Therefore, among healthy older women, standard fractionation RT with a boost to the lumpectomy cavity is considered a standard component of breast-conserving therapy.
Studies in older women have found no important increase in RT toxicity. The SIOG panel recommends that RT after breast-conserving surgery and adjuvant systemic treatment should be considered in all older women with breast cancer. Factors that should be taken into account include life expectancy, patient health and functional status, mortality risk from comorbidities , and risk for local recurrence.19
Since absolute risk for local recurrence is lower in older women, the benefits of RT may decline with age. In addition, the schedule and duration of conventional RT may be challenging for older women who have limited mobility or transportation. Alternatives that demonstrate promising early results include hypofractionated RT schedules, more rapid fractionation, and partial-breast rather than whole-breast irradiation.20
Colon Cancer In The Elderly
The most common intraabdominal cancer is colon cancer, which today has a good prognosis. Intestinal disorders are common in older people, and therefore they may be left unexamined. On the other hand, emphasis is currently placed on the active investigation of elderly patients with intestinal symptoms, because the risk of cancer increases significantly with age. The risks related to surgery of the abdominal cavity are significant. Therefore, symptomatic treatment may be settled with in cases where patients have other serious illnesses, such as heart failure. Colon and rectal cancer surgery also improve the quality of life of the elderly patient, even if the surgery would not prevent the progression of metastases outside the intestine. Chemotherapy is used as adjuvant therapy after colon cancer surgery. Adjuvant treatments cannot be performed if the patient has other medical conditions and multiple other medications. However, chemotherapy given as tablets may be suitable for the elderly patients with no heart disease. Advanced colon cancer treatment has a number of medicinal options. Chemotherapy treatments and biological drugs delaying cancer progression and relieving the symptoms may also be considered in elderly patients. It is important to always anticipate the potential harm for the heart or the kidneys.
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Management Of The Frail Elderly With Breast Cancer
Hyman B. Muss, MDOncology
Cancer is the second leading cause of death in the United States, and the incidence of cancer increases with increasing age. From 1980 to 2003, the proportion of cancer deaths has increased, while deaths from heart disease and stroke has trended down, reflecting our aging population. In addition, data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program from 1998 to 2002 indicate that 56% of newly diagnosed cancer patients and 71% of cancer deaths occur in individuals greater than age 65. The number of older adults with a cancer diagnosis will continue to increase as the population ages and life expectancies increase. In the United States, it is estimated that by 2030 70% of cancer patients will be over the age of 65.
Breast cancer is a disease of aging, and its incidence increases with age . Approximately 1 in 125 women between the ages of 65 and 85 will develop breast cancer each year, as compared to 1 out of 390 women between the ages if 45 and 55. Given the increasing incidence of breast cancer with age and an increasing proportion of the US population over age 65, oncologists will be caring for an ever-larger number of elderly patients.
Characteristics of Frailty
Tools for Geriatric and Frailty Assessment
Interventions to Prevent or Redcue the Severity of Frailty
Treatment of Breast Cancer in the Frail Elderly
Diagnosis and Treatment of the Primary Lesion
Systemic Adjuvant Therapy
Metastatic Breast Cancer
Individualized Breast Cancer Treatment For Older Adults
Tran says her groups approach to dealing with breast cancer in patients of any age is highly individualized. We recommend both the treatments and the order in which the patient will receive them, which is very important. For instance, radiation is not common before surgery, since it makes wound healing more difficult.
She notes that most cancers are found early, and generally surgery is the first step in treatment. But for cancers that are more advanced when they are diagnosed, starting out with chemotherapy can offer some advantages.
In cases where the cancer is advanced, chemotherapy is often done first to shrink the tumor. Another benefit of doing chemotherapy first is the tumors response to the chemotherapy gives us information on your prognosis, and surgery afterward can confirm those findings.
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Risk Factors Of Cancers
Age in itself significantly increases the risk of cancer. Also other risks associated with lifestyle accumulate in the elderly. However, it is never too late to make healthy lifestyle changes. Thus quitting smoking, limiting alcohol use, favoring a vegetable-rich diet, weight control, and physical activity may all be recommended to the elderly.
A healthy lifestyle improves overall health comprehensively, which helps older people maintain better well-being. Good general condition and muscle strength, independence, as well as controlled diabetes and blood pressure can decisively work in favor of active treatment, if the patient is for example about to have a large operation of the abdominal cavity or lungs, and removing the cancer completely would be possible.
Have Other Needs Unique To Older Cancer Patients Been Identified
Weve certainly come to appreciate that because so many older individuals live alone and may have financial limitations, its important to care for nonmedical needs. At Memorial Sloan Kettering, our long-established 65+ Program supplemented in 2009 with the creation of a dedicated Geriatrics Service, headed by Beatriz Korc-Grodzicki includes experts in medical and surgical oncology as well as geriatrics, finance, nutrition, occupational therapy, music therapy, pharmacy, physical therapy, psychiatry, social work, and palliative care.
Consultations are available to help determine what sort of aid an older patient might benefit from as he or she undergoes cancer treatment. And we perform a preoperative evaluation on patients age 75 and older to assess the risk of surgery and help prevent postoperative complications. Nothing could make more sense in the context of the aging population.
Social workers with psychological training assist with everything from emotional counseling to nutrition advice and guidance in setting up transportation for follow-up appointments. They also look for ways to ease the strain on spouses and other caregivers. All this makes a difference when it comes to older people being able to handle treatment that will truly help them overcome cancer.
Members of the Geriatric Service meet regularly to discuss whats appropriate for each person. Its the very definition of individualized treatment.
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Aging Out Of The Mammogram
For many women, regular breast cancer screening is standard medical protocol. But for older women, should it be?
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By Paula Span
When Janet Halloran last saw her primary care physician, the doctor asked whether she had undergone her annual mammogram. Yes, she replied, she had.
At 76, Ms. Halloran, a real estate broker in Cambridge, Mass., is past the age that most medical guidelines recommend breast cancer screening for someone with no history of the disease. Even for younger women, the guidelines call for a mammogram every other year, not annually.
So Ms. Halloran could consider stopping mammograms, or at least having them less often. But her doctor has never discussed that prospect. She says, These are the things you need to do, Ms. Halloran said. Besides, she added, its an easy test: Go once a year, hold your breath and youre done for another year. Its just routine.
But for older women, should it be?
Theres been a lot of uncertainty, said Dr. Xabier Garcia-AlbÃ©niz, an oncologist and epidemiologist at RTI Health Solutions and lead author of a new observational study that tries to answer that question. This is an area with a complete lack of randomized clinical trials.
Yet more than half of women over 75 have had a screening mammogram within the past two years, the Centers for Disease Control and Prevention reported in 2018.
If Im 70 Or Older Will Invasive Breast Cancer Be Fatal
Though a cancer diagnosis is scary at any age, older adults may feel more vulnerable. But Tran says there are reasons not to panic.
In patients 70 years old or older, most of the time, the invasive cancer is hormone receptor positive, which means it is a slower-growing cancer.
Most patients treated for invasive breast cancer survive, she says. Even when you are diagnosed at an older age, you can successfully complete your therapy, go on living and eventually die from causes other than breast cancer.
This is especially true for those who are in good general health at the time of their diagnosis and who are able to care for themselves.
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What Are The Early Signs Of Breast Cancer
Breast cancer symptoms can vary for each person. Possible signs of breast cancer include:
- A change in the size, shape or contour of your breast.
- A mass or lump, which may feel as small as a pea.
- A lump or thickening in or near your breast or in your underarm that persists through your menstrual cycle.
- A change in the look or feel of your skin on your breast or nipple .
- Redness of your skin on your breast or nipple.
- An area thats distinctly different from any other area on either breast.
- A marble-like hardened area under your skin.
- A blood-stained or clear fluid discharge from your nipple.
Some people dont notice any signs of breast cancer at all. Thats why routine mammograms and are so important.
Lung Cancer In The Elderly
Lung cancer is still one of the cancers with the worst prognosis, and smoking is its main risk factor. The decrease in mens smoking is visibly seen in the reduction of lung cancer cases. Surgery is a curative treatment for early-stage lung cancer. It is, however, only rarely possible, and the poor functioning of the heart or lungs of the elderly patient may prevent the surgery. Local radiation therapy can be used to relieve the symptoms of lung cancer, regardless of age. Chemotherapy treatments for lung cancer are quite severe and their effectiveness weak, so they are rarely given to elderly patients.
In recent years, new biological medicines have become available on the market, and they are used in the treatment of certain rare types of lung cancer.
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How To Get Screened For Breast Cancer
If you notice youve experienced some of the symptoms of senior breast cancer, visit the doctor as soon as possible. Not next week, not next month. As soon as the doctor can fit you in. When making the appointment, you should note you the symptoms you have experienced. You should also get a yearly test even if you arent showing any symptoms.
Your doctor will perform a handful of tests to determine if your symptoms are the result of the presence of cancer in your breasts. Some of these tests include:
Qol In Older Breast Cancer Patients
QoL is one of the most important outcome measures in cancer researches due to the medical and public health advances that have determined an interest in measuring quality of treatment not only on the basis of live-spearing and increased life span but also on the basis of QoL in treated patients. It has been shown that assessing QoL in cancer patients could contribute to improve treatment outcomes and could even have a prognostic value . The concept of health-related quality of life covers a broad number of aspects that can affect physical and mental health. When assessed on the individual level, health related QoL includes perceptions of physical and mental health, that can be determined by risk factors, health conditions, functional status, social support, and socio-economic status. On a community level, health related QoL includes all factors that can influence health perception and functional capacity, such as use of resources, policies, and practices that have implication for health. Self-assessed health status has been proven a more powerful predictor of mortality and morbidity than many objective measures of health : patient-reported QoL has also been found to predict response to treatment and adherence to prescribed therapies, which is especially relevant to older women with early breast cancer who should undergo a long treatment course with aromatase inhibitors .
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Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Common Breast Cancers In Older Adults
The most common cancer diagnosed in this age group is invasive ductal carcinoma, or IDC , followed by invasive lobular carcinoma . These cancers arise in different tissues of the breast, but are treated in similar ways.
Most invasive cancers in this age group are hormone receptor positive. Hormone-positive breast cancers are considered slow-growing tumors, which can mean a good overall prognosis.
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Treatment For Physical Symptoms
The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.
Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.
Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.
Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.
Signs And Symptoms Of Breast Cancer
One of the most important steps in beating breast cancer is catching it at the earliest possible stage. This is why its vital to know the signs and symptoms of senior breast cancer.
The most common symptom is a lump on your breast. While most lumps on the breast are benign, about 20 percent are cancerous. Theyre especially concerning if youre over 40, because it is more likely the lumps are connected to cancer rather than an injection or benign tumors. The root cause of the lump is often seen during mammograms before they develop into lumps on the breast. So while lumps can be a sign, there are other signs on and around the breast that can indicate the presence of senior breast cancer. These include:
Lump on the Breast:
The most common symptom is a lump forming on the breasts. While 20% of lumps are cancerous, the risk increases with age.
Discharge from the Nipple:
Any sort of nipple discharge, whether its clear or discolored, runny or thick, can be an indication of breast cancer. However, the cause can also be a side effect of other medical issues or from breastfeeding, especially if its a milky color.
Swelling and Soreness:
Breast cancer can cause a general swelling or soreness of your breasts. The swelling would be significant enough to change the size of the breast that is effected, even if one is already a different size than the other. The swelling can affect the whole breast or a part of it, and it can change the overall size and shape of the breast.
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