Key message:
Elderly breast cancer patients are less likely to receive surgical treatment or radiotherapy than younger patients.
Breast Cancer in the Elderly - NCIN Data Briefing
Introduction
In the UK in 2006, 49,452 breast cancers were diagnosed, of which 15,499 (31%) were in patients aged 70 and over. This briefing examines variations in management and route of presentation of the invasive (95%) and non-invasive (5%) tumours diagnosed in these elderly patients of whom 15,327 were female and 172 male.
Age at diagnosis and route of presentation
The majority of breast cancers are diagnosed in women over 50 years of age. Women aged 50-70 are invited for NHS mammographic screening (50-64 in Northern Ireland). Although those over 70 years may self-refer, in 2006 only 9% of breast cancers in patients 70 years and over were screen-detected (Figure 1). Women aged 71-73 years will be included in the planned extension of the screening programme outlined in the Cancer Reform Strategy (England) which is likely to result in a greater proportion of screen-detected breast cancers in this age group in future.
Figure 1 : Number of breast cancers, by age at diagnosis and route of presentation
Surgical treatment
Surgical treatment was recorded for 90% of patients aged 50-70 years, compared with 58% for those aged 70 and over (Figure 2). For the older patients, a higher proportion of surgical treatment was recorded for screen-detected cancers (95%) than for cancers diagnosed symptomatically (54%). In women aged 70 and over, those with screen-detected breast cancers had a higher proportion of breast conserving surgery (71%) than those who presented with symptoms (40%). The decrease in surgical treatment with age was quite marked for symptomatic patients; with 85% of symptomatic patients aged under 70 having surgery compared with only 54% of the 14,034 symptomatic patients aged 70 and over.
Figure 2 : Surgical treatment, by age at diagnosis and route of presentation
Radiotherapy
Patients with invasive breast cancer treated with breast conserving surgery are usually offered radiotherapy. Where no radiotherapy is recorded this may be a data quality issue or there may be a clinical contra-indication. Figure 3 contains information from the four English regions and two Celtic countries with good quality radiotherapy data. It shows a decrease in the use of radiotherapy with age at diagnosis. In 2006, 74% of patients aged 70 and over with conservatively treated invasive breast cancer had radiotherapy treatment recorded compared with 84% of those aged under 70.
Figure 3 : Radiotherapy for invasive conservatively treated breast cancers, by age at diagnosis
Further information
This data briefing is based on the All Breast Cancer Report “A UK analysis of all symptomatic and screen detected breast cancers diagnosed in 2006” which includes detailed methodology, a list of data sources and references. Treatment data and adjuvant therapy data are available in this report.
The All Breast Cancer Report is available to download from the NCIN website, the NHS Breast Screening website and the WMCIU website. This briefing is one of a series published on the main findings from the 2009 All Breast Cancer Report. Copies of the briefings on Ethnicity and the Elderly are available for download from the NCIN website.
The management of non-invasive breast disease is studied in the Sloane Project which is funded by the NHS Breast Screening Programme.
Find out more
The West Midlands Cancer Intelligence Unit is the National Cancer Intelligence Network lead cancer registry for breast cancer.
Other useful resources within the NCIN partnership
Cancer Research UK CancerStats – Key facts and detailed statistics for health professionals.