Older Women Foregoing Surgery for Breast Cancer

A new study explores the multifaceted reasons and priorities that explain why older women are avoiding surgery for breast cancer (BC).

Researchers at the University of Manchester (United Kingdom) reviewed 800 women (predominantly from North West England) who took part within 30 days of diagnosis of BC in a quantitative survey about health-related quality of life and treatment decisions. They then conducted in-depth interviews with the 28 women over 70 years old with operable BC who were receiving primary endocrine therapy (PET) as their treatment instead of surgery. The interviews focused on the women’s perceptions of why they were being treated with PET, rather than undergoing surgery.

Based on reasons for PET, the patients were divided into three groups. The first group absolutely ruled out surgery to treat their BC; these patients were not interested in maximizing their survival and rejected surgery, citing their age or concerns about impact of treatment on their level of functioning. The second group considered surgery, but chose to have PET, with most specifying that if PET failed, then they could have the operation; the patients viewed this as offering them two options of treatment. The third group included patients with comorbidities, and in most cases it was the surgeon who asserted that the comorbidities were incompatible with surgery. The study was published in the February 2015 issue of Psycho-Oncology.

“Viewing themselves at the end of their lives led women in the ‘patient declined’ group to question what difference surgery would make,” concluded lead author Anne Marie Sowerbutts, PhD, and colleagues. “The thinking behind this seemed to be that life for them was limited so although the cancer may be removed, because of their age, they would develop another disease. This interpretation was reinforced by several patients saying that they would have had the operation if they were younger.”

Breast cancer is the most common cancer in women in England, with incidence rates of 222.9 per 100,000 for 45–49 years old, and rising to 439 per 100,000 in those aged 90 years and older. UK national guidelines stipulate that patients of all ages with early-stage BC should be offered surgery, unless precluded by significant comorbidity, and following surgery adjuvant treatment (radiotherapy or chemotherapy) should be considered.

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