Too old to treat?

I remember my late mother-in-law had a routine check-up when she was in her late eighties and they found a shadow on the lung. No one was very sure what it was and the doctor said that they would watch it as they did not want to operate on her because of her age. Before any discussion could be had my mother-in-law said that she wouldn’t contemplate any treatment anyway as she had lived long enough! There was no question of her being manoeuvred into this position – no one manoeuvred her into doing anything! As she then survived until just a few months short of her century this was probably a wise decision.

But when is old? I am sure that you are as shocked as we are to learn about the discrimination faced by older women with breast cancer. NHS doctors believe women are being denied treatments due to age rather than ability to benefit and this was widely reported in the press last week. A national consultation which was published last week revealed that women over the age of 65 are at risk from exclusion from chemotherapy for example. Only 16 per cent of women over 65 received chemotherapy compared with 77 per cent under 50. We also know that older postmenopausal women are less likely to receive surgery than younger ones. The only acceptable criteria for older people not receiving treatment are personal choice and poor health.

There is a deep irony here as the greatest risk factor for breast cancer is age – the risk increases the older you get. As older postmenopausal women (aged 70 or over), make up roughly a third of the 45,700 women diagnosed with breast cancer each year, it is imperative find out the reasons why they may not be receiving potentially beneficial treatments.

This is why Breast Cancer Campaign is currently supporting research in Manchester which aims to find out whether some older women with operable breast cancer are not being given surgical treatment because of their age rather than choice, health or ability to benefit.

The researcher will interview 550 patients aged 70 and over with operable breast cancer about their general health and choice of treatment. She will use the information collected to establish whether decisions about providing surgical treatment are being based on age even when the patient choice and health would make appropriate to operate.

Knowing the extent to which older women are not given surgery as a result of age, patient choice and poor health will help researchers establish whether these women are being discriminated against. This will provide researchers with evidence to encourage a change in practice and ensure all women receive the best treatment possible regardless of their age.