It is very common for surgery to be recommended when there is a diagnosis of breast cancer. This is also the case among older women, who may not be in best shape for such. A recent study suggests that a procedure may be of not much help and can be outright too dangerous for the elderly.
In many or most cases, surgery is the first-line intervention against breast cancer. This is done to remove as much as possible of a tumor from the breast.
Doctors typically order a biopsy when they notice a mass in the breast. This is an examination of tissue removed from the organ to determine the nature of tumor and appropriate treatment, if needed. A diagnosis of the disorder most times leads to surgery.
Some doctors even recommend that women having ductal carcinoma in situ (DCIS), which is also called Stage 0 breast cancer, should go for mastectomy.
However, new evidence shows that such drastic remedial measures do not make much difference, especially in the elderly. A study published recently in the journal JAMA Surgery indicated that much.
Among nursing home residents, breast cancer procedures are the most common forms of cancer treatment. But available data on its efficacy leaves much to be desired.
In the new study by some University of California San Francisco researchers, the benefits of breast cancer surgery for almost 6,000 residents of nursing homes who had a procedure were assessed over a period of 10 years.
These women, whose average age was about 82, had several health challenges that are associated with the elderly. Their rates of arthritis, diabetes, cognitive impairment and other age-related medical conditions were high. They required significant assistance with regular daily tasks.
The variety of health challenges already placed a limit on how long these subjects can live. But doctors still recommended breast cancer surgery to them all the same.
It is not very surprising, then, to learn that these elderly women didn’t fare much better. Conditions of nursing home residents worsen and they die, regardless of surgery.
A risky affair
Breast cancer surgery is believed to be associated with minimal risks among younger, healthier women. This is very understandable. But it is a different proposition entirely for frail, older women with health issues.
“The trajectories for these patients tends to be poor to begin with,” study lead author Dr. Victoria Tang said.
A very high mortality rate was reported among the nursing home residents in the study. Between 2 and 8 percent of them died within a month of having a procedure, depending on the particular type they had.
Medical experts use the 30-day mortality rate as the yardstick for usefulness of surgery. Loved ones of patients, however, most certainly won’t consider living a few days or weeks beyond 30 days as making a procedure worthwhile.
The findings indicated that breast cancer surgery made practically no difference in likelihood of death.
“We’re taking people who are more likely to die of something else, and putting them through hospitalization and surgery, with all those risks,” study co-author Dr. Rita Mukhtar said.
Surgery may actually diminish the quality of life for whatever time elderly patients have left to live, Mukhtar said.
The one-year mortality rate of the subjects was also on a very high side. Between 29 and 41 percent died within a year of the surgery.
The decision by the U.S. Preventive Services Task Force to change the guideline for beginning of mammograms to 50 years, up from 40, was in response to aggressive treatments of breast cancer. That was due to lack of significant evidence that earlier screening (and treatment) offered more benefits.