It's Breast Cancer Awareness Month, and I had a question from one of my clients about why should she worry about breast cancer "at her age?" We devote a lot of press to mothers and daughters and sisters and spouses, but what about grandmothers and great-grandmothers? What I am going to share with you in this posting may seem a bit of a surprise, because we tend to focus a lot of our attention on women who are in their prime when we think about breast cancer. We may even think that older - and very post-menopausal - women need not be as concerned about a medical risk often associated with hormonal activity.
There has been research at Memorial Sloan-Kettering that basically says that regular testing works as well if not better for older patients as it does for younger patients, because if the cancer is caught early - and therefore small - these women have a very favorable prognosis. In other research at Beth Israel Deaconess Medical Center in Boston doctors followed about 65,000 women who had been diagnosed with breast cancer using Medicare data alongside women without breast cancer who numbered 170,000. Women over 65 who were diagnosed in this group with what is called ductal cell carcinoma in situ and stage I cancer - what they refer to as DCIS - were just as likely to survive for the study period of eight years as those without this diagnosis. Now, this is the amazing part. The women who were diagnosed before 80 years of age actually lived a bit longer than women who did not have breast cancer.
Treatment decisions can be complicated for older patients. And it is mostly because older patients tend to have other medical issues going on which providers refer to as co-morbidities. As we get older, we may also have high blood pressure, diabetes, or something else. In other research physicians have found that more conservative, non-surgical, non-radiation, even non-chemotherapy can be effective. But again, it comes down to early detection to avoid the complications of a more aggressive cancer.
Even if we just come out and say women who got breast exams were just taking better care of themselves, early detection seems to be working better for older women than their younger counterparts. And, of course, we should take the larger lesson that early diagnosis and treatment are incredibly important for any elder for whom we are caregivers. When I first looked into breast cancer and older patients I actually thought I was going to find professionals suggesting it is not as essential to have breast exams as patients get older. The research seems to be saying that doctors ought to be talking to their female patients at every age, because stage II and stage III patients did not fair as well. Talk to your provider to see what is optimal for the age of the elder for whom you care.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families. Please email your questions to Charlotte Bishop.
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