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BMC receives $3.3M grant to study breast cancer in elderly women
By David J. Craig
A doctor treating an 85-year-old breast cancer patient faces a dilemma. Do the potential benefits of a conventional treatment strategy -- one that includes, say, surgery followed by radiation -- outweigh its risks? And how should a physician weigh the possibility that the patient could die of an unrelated condition before the cancer treatment is completed?
These are particularly difficult questions because there is scant information about the effectiveness of many medical treatments for older adults, in part because few elderly Americans take part in clinical medical trials, says Rebecca Silliman, a MED professor of medicine and an SPH professor of epidemiology. She has studied breast cancer for two decades, and she says that a potential consequence of that lack of data is that older women with the disease do not receive treatments that would benefit them.
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| Rebecca Silliman. Photo by Vernon Doucette. | |
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Silliman hopes that a new study she is directing with a $3.3 million grant from the National Cancer Institute will help physicians and their elderly patients make better informed decisions regarding breast cancer treatment. Her research team at Boston Medical Center will study 2,180 U.S. women, age 65 and older, who were diagnosed with breast cancer between 1990 and 1994 to determine how particular types of treatments relate to cancer recurrence and mortality.
“More than half of all new breast cancer cases are diagnosed in women who are 65 years of age or older, yet fewer than 10 percent of breast cancer patients in clinical trials are in this age group,” says Silliman, who also is chief of the BMC geriatrics section. “And when there is no evidence to support a type of treatment, often what ends up being done is less that what maybe should be done.”
Silliman and her colleagues, working with six health-care systems across the United States, will examine the medical records of participants over a 10-year period to determine the effectiveness of breast cancer treatments such as lumpectomy, mastectomy, chemotherapy, radiation, and oral medications like tamoxifen. Other BU faculty on the research team include Theodore Colton an SPH professor of epidemiology, Marianne Prout, an SPH associate professor of epidemiology, and Timothy Lash, a SPH assistant professor of epidemiology.
“Essentially, we want to determine what are the adverse consequences
of older women receiving less than what is considered the standard treatment
for younger women,” says Silliman. “But we also want to determine
if there are subgroups of older women for whom it might be all right to
receive less therapy than is given to younger women. You certainly don’t
want to err on the side of undertreatment, but you don’t want to
overtreat people, either.”
Breast cancer, the most common form of cancer among U.S. women, is deadly
in about 20 percent of all cases, and is the leading cause of cancer death
among women aged 40 to 55. While cases among middle-aged women often are
well publicized, breast cancer incidence and mortality rates actually
increase dramatically with age -- a quarter of all breast cancer deaths
in this country occur among women over 80.
But older women tend to receive less aggressive treatments, Silliman says, in part because their bodies are considered frail, and because they may be seen as likely to die of another condition before the breast cancer proves fatal. Clinical data regarding breast cancer treatment for this age group, meanwhile, is unavailable because elderly people tend to have multiple health problems and thus are difficult to study. Their complicated medical conditions often make them ineligible for clinical trials, Silliman says.
“The bottom line is that there are no compelling clinical trial data to suggest that the efficacy of treatment is age-specific,” she says. “And preliminary evidence does suggest that variations in care do matter with respect to outcome among older breast cancer patients. Another thing that has to be taken into consideration is the fact that having breast cancer while you’re dying of something else may make comfort care all the more challenging. So it’s not just death that’s the end point to consider, but there are serious quality of life issues as well.”
Silliman hopes that her study also will contribute to public knowledge
about older women’s health. “The fact that half of new breast
cancer cases occur in women over the age of 65 is not well appreciated,”
she says. “And given that incidence of breast cancer rises at least
into the 80s, and considering that a healthy 85-year-old woman has a future
life expectancy of nearly 10 years, the disease in this age group is a
major public health concern.”
The study’s collaborating health-care systems include Fallon Healthcare
in Worcester, Mass., as well as systems located in Albuquerque, Detroit,
Minneapolis, New Haven, Oakland, and Seattle.
18
April 2003
Boston University
Office of University Relations