9/3012 Everything Comes In Three's pr

My breast mastectomy was three months ago.  My oncologist radiation Dr. Charles Hechtman said it will take three months for the burnt red of my skin radiation to go away.  I will have the other breast taken off in January 2013.  That is three months from now.  That's the three's for you!  Hugs,phyllis 05/06/1933   www.women70andover.com

9/29/12 Went to a Cancer Symposium pr

Today I went to a breakfast/lunch gala, informative Breast Cancer Symposium at the News Journal Building on Beach Street, Daytona Beach.  It was most interesting.  Two breast cancer survivors gave a talks.  I learned alot.  Talks also from a surgeon, radiology doctor, dietitian, physical therapy and many more helpful people.  This all started at 7:30 a.m. I left there at 10:30 a.m. and went to a Halifax Hospital Volunteer luncheon.  That too was inspiring.  There were volunteers there that had given as much as 7,500 hours through the years! Hugs,phyllis 05/06/1933    www.women70andover.com

9/28/12 Nothing Is Really Never Over? pr

Cancer Radiation is over!  Today was the last of it.  Yesterday and today, the radiation disk holding the special glass made just for me was placed over my No Breast, almost tight.  Just like you would get right up to someone’s face, nose to nose.  My arm had to be stretched even higher behind my head and I had to grab the bar, just for each hand to grab. I could feel the radiation beams hitting my muscles in my No Boob area.  It did hurt.  The procedure, once they set you up in your radiation bed goes very fast.  Maybe even under three minutes.  The rib cage under just above my side is very tender, also my chest muscles.  I did it!  That is the main thing!  My wellness journey continues.  I have an appointment with my surgeon next week to be scheduled in January 2013 to have the other healthy breast removed.  We all know the cancer can return there.  Also, it is not comfortable in my clothes with one breast remaining.  I do love the young girl feeling of no bra.  For me it is a sleek feeling.  Dr. Hechtman said it would take about three months for the red skin left from the radiation to go back to my normal skin color.  That is what clothes are for!  Cover up Baby! Hugs, phyllis 05/06/1933 www.women70andover.com

9/27/12 Are We There Yet? pr

Is it over?  Are we there?  Are we done?  Remember all those things your kids said in the car on a trip?  It seems I am the same.  This must mean I have never grown up.  It is too hard to grow up.  Today is the last day of my Radiation treatments.  Like all good and bad things, the residue of the treatments lingers with me.  I have looked at my No Boob area and try hard to think what it does look like.  It reminds me of a thin wool piece of dark orange red material stretched over this area.  There is no resemblance to skin.  I say to myself as I put the aloe gel on.  ”Phyllis you are a mess!  You poor thing.”  Somehow, this makes me feel better.  Then I put my big cotton tee shirt over it and nobody, but me knows I am this mess.  Hugs,phyllis 05/06/1933   www.women70andover.com

9/26/12 A New Country On The Map pr

 I live in Cancer Country.  In many ways it is similar to other foreign countries.  You have a language all just for cancer that includes medicine side effects.  You are anxious for all the tours of the country, like all the doctors appointments.  You start digging with research for yourself to get to know the ins and outs of this Country called Cancer.  The weather of this country is determined by how you feel and what you are physically able to do.  The more physically able you are gives you the strength to learn more about  Cancer Country.  The more you learn and see lets you find a comfort zone for yourself that spills over to your family and friends.  Stretching oneself and doing volunteer work gives you the chance to give back to others in this new Country you find yourself touring in.  When you realize, hey you might even live in this  Country called Cancer.  It is not that you like everything you see, on the other hand you know you fit in this Cancer Country because you have found a place you fit in with your peculiarities/ your likes and dislikes.  Even the foods in this Country you find you can eat.  The people eat like you do in many ways.  Some days they like only peanut butter and so forth.  You do not have to explain to these people, as they are similar to you, they see many of the same doctors you do.  They know what it is to be tethered  to the hospital for Chemo and Radiation treatments.  They even wear the same blue tags on a ribbon around their necks, with a picture that they scan when they come into the hospital.  You can start talking with them easily.  They are not on their social guards.  Where you live is not important.  They know it was a chore for you to get to this Country called Cancer. Hugs,phyllis 05/06/1933  www.women70andover.com 

9/25/12 Two More Days of Radiation!

I am almost done with this treatment.  I am red crisp.  It will take two more days to be well done!
I am lucky!  Yesterday I was able to go to CVS and found a natural aloe gel that has given me relief.  Trust me, I know I am burned, on the other hand it is tolerable now! Hugs,phyllis 05/06/1933  www.women70andover.com

9/25/12 Good Medicene pr

Arimidex (Arimidex 1mg  I take one pill daily.

This is the medicene I take to prevent the cancer tumors reocurring in my body. The side effects I have are:

Arthritis, headaches, hot flushes, joint pain and stiffness, bone pain, loss of sleep. Thank heaven these are my only side effects.  I have learned to live with them with style and grace!  When I have joint pain ect. I say, “Phyllis, just walk like you do not hurt! I do and I am able to walk the pain away, like it never bothered me.”  (until the next time!) Trust me!  I know I am very lucky.  I could be sitting in a Chemo chair with I.V. medicine dripping in me, instead I have quality of life.  Walking daily, full of energy, time to volunteer at the Chemo center at Halifax Hospital in Ormond and Daytona Beach, write my blog, draw, bake and cook, read, do research of my writings, enjoy movies and my kind husband, my support center and friends and family and the heavens above.  For me that’s a lot to be thankful for and I think a lot of things are funny, cancer not being one of them, instead my dog Annie makes me laugh and Woody Allen and most of all I laugh at myself! Hugs, phyllis 05/06/1933   www.women70andover.com comments? Send to phyllisreh@aol.com

Side effects

Information specific to: Arimidex 1mg tablets when used in Breast cancers. Side-effects A medicine is only made available to the public if the clinical trials have shown that the benefits of taking the medicine outweigh the risks. Some side-effects may be serious while others may only be a mild inconvenience. Everyone's reaction to a medicine is different. It is difficult to predict which side-effects you will have from taking a particular medicine, or whether you will have any side-effects at all. The important thing is to tell your prescriber or pharmacist if you are having problems with your medicine. Very common: More than 1 in 10 people who take Arimidex arthritis headaches hot flushes joint pain or stiffness nausea osteoporosis skin rash or rashes weakness Common: More than 1 in 100 people who take Arimidex abnormal laboratory test results allergic reactions bone pain carpal tunnel syndrome diarrhoea hair loss high levels of cholesterol in the blood loss of appetite sleepiness vaginal bleeding - seek medical advice if bleeding is persistent vaginal dryness vomiting Uncommon: More than 1 in 1000 people who take Arimidex liver problems trigger finger urticaria

 

9/24/12 From Journal of Oncology pr

This artical is most vital for women 60 and over, and should be vital for women 70 and over!

My cancer mass is termed Stage 2b.  This means it can be large as I had 14 cm and it was not in the lymph nodes or organs, bones or brain.

breast cancer sub-type	Estimated Overall Survival
DCIS-ductal carcinoma in situ)	98% to 100%
Tubular breast carcinoma	95%
Infiltrating lobular carcinoma	86%
Infiltrating ductal carcinoma	84%
Medullary breast carcinoma	78%
Mucinous breast carcinoma	75%
Inflammatory breast carcinoma	32% to 42%

Infiltrating/invasive lobular breast carcinoma

I have lobular breast carcinoma

      Infiltrating lobular carcinoma usually appears as a subtle thickening in the upper-outer breast quadrant. As the name suggests, these tumours originate mostly in the breast lobules ( where the milk is produced) rather than the lining of the breast ducts. It is a less common type of breast cancer, accounting for about 5% of all cases. Prognosis for infiltrating and invasive lobular breast carcinomas will naturally be influenced by tumor size and grade and stage. But, lobular breast cancers, when positive for estrogen and progesterone receptors, tend to respond very well to hormone therapy. The overall survival for infiltrating lobular carcinoma is a little bit higher than for ductal carcinoma. Survival rates range from about 77% to 93%, but on av© 2010 by American Society of Clinical Oncology

Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival

1.      Mara A. Schonberg,

2.      Edward R. Marcantonio,

3.      Donglin Li,

4.      Rebecca A. Silliman,

5.      Long Ngo and

6.      Ellen P. McCarthy

+ Author Affiliations

Conclusion Women age ≥ 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.

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INTRODUCTION

Women age 80 years and older are the fastest growing segment of the US population, and breast cancer is relatively common among these women with nearly 400 cases per 100,000 women.¹ Despite the high incidence, little is known about breast cancer characteristics, treatment choices, and survival among the oldest women. These data are important for decision making around breast cancer detection and care. Few randomized controlled trials that evaluated the effectiveness of breast cancer treatments included women age 80 years or older, and most observational studies were limited by small sample sizes in this age range.^2–4 Studies using the Surveillance, Epidemiology and End Results (SEER) -Medicare data set have examined the effectiveness of radiation treatment and chemotherapy among older women with breast cancer.^5–8 However, these studies consistently exclude women with missing stage and those without a histologic diagnosis and/or known hormonal receptivity. Meanwhile, women age 80 years or older are most likely to fall into these categories.^2,4,9–12 Missing data may be one reason that studies differ on whether elderly women present with higher stage disease but with less aggressive tumors than younger women.^2,13,14

Although studies consistently show that older women are undertreated for breast cancer, the impact of undertreatment on breast cancer survival among older women remains controversial. Gadjos et al³ found that rates of recurrence were not increased when undertreated women (older than 70 years) were compared with conventionally treated patients, while others have found that undertreatment is associated with recurrence and decreased survival.^2,15,16

The purpose of this study was to examine variations in breast cancer tumor characteristics, initial treatments received, and survival among women age 80 to 84, 85 to 89, and ≥ 90 years with early-stage (stage I or II) breast cancer compared with younger women (age 67 to 79 years).

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PATIENTS AND METHODS

We used data from the National Cancer Institute's linked SEER-Medicare data set. Since 1992, SEER has included 11 population-based tumor registries in the metropolitan areas of San Francisco/Oakland, Detroit, Atlanta, and Seattle; Los Angeles County; the San Jose–Monterey area; and the states of Connecticut, Iowa, New Mexico, Utah, and Hawaii.¹⁷ These areas cover approximately 14% of the US population.¹⁸ We identified all women age 67 years or older newly diagnosed with breast cancer or ductal carcinoma in situ between 1992 and 2003, excluding those diagnosed on death certificate or at autopsy (n = 102,184). We then excluded women diagnosed with a second cancer within 12 months after their primary breast cancer diagnosis because health care claims cannot reliably discriminate between procedures performed for the index cancer versus the second cancer (100,404 remaining). We further excluded women who had Medicare-managed care insurance within 2 years before through 1 year after diagnosis because their claims data are incomplete (75,286 remaining), and we further excluded women with gaps in their Medicare coverage (66,951 remaining).

We then considered excluding women missing data on American Joint Committee on Cancer (AJCC) Staging 3rd edition (13.5% overall or 19% of women age 80 to 89 years and 39.5% of women age ≥ 90 years), women with a history of non-breast cancer (8.7%), and women without a histologic diagnosis (3.1%). However, when we considered these three exclusions together, 21.9% of our sample would be excluded, including 48.7% of women age ≥ 90 years (Appendix Table A1, online only). Since our study focused on breast cancer characteristics among the oldest women, we chose not to make these exclusions. Instead, we constructed an algorithm using data available on tumor characteristics (extent, number of positive lymph nodes, lymph node invasion, tumor size, and histology) to impute stage for women with missing stage (Appendix A, online only). After imputing stage, only 1.4% of women were still missing stage data. For cases with both known and imputed (AJCC 3rd edition) stage, we tested the extent to which the two measures agreed beyond chance using a two-sided κ statistic. Because of the observed excellent agreement (the two-sided κ statistic was 0.997), we used imputed stage for those women with missing stage in our primary analyses. Our sample included 49,616 women with known or imputed stage I or II disease.

Tumor Characteristics

From SEER, we obtained data on tumor size, regional lymph node involvement, tumor grade, histology, estrogen receptivity (ER), and progesterone receptivity. Variable definitions can be found in Appendix B (online only).

Treatments

We used data from both SEER and Medicare claims to classify initial treatment with surgery or radiation therapy (RT). We considered women to have received surgical and/or RT if reported in SEER or if there were Medicare claims for these treatments within 12 months following diagnosis. We categorized initial treatment as mastectomy, breast-conserving surgery (BCS) plus RT, BCS alone, or no initial surgery. We used Medicare claims to identify receipt of chemotherapy within 12 months following diagnosis among women with ER-positive and lymph node–positive disease, since this population is thought to derive benefit.^6,7,19 Women were classified as having any claim versus no claim for chemotherapy (Appendix B).

Survival Outcomes

Survival time was measured from the patient's date of diagnosis until death or December 31, 2005, whichever came first. SEER tracks vital status annually, and death certificates are used to capture underlying cause of death (Appendix B).

Covariates

Patient characteristics included race/ethnicity, marital status, SEER registry, metropolitan versus nonmetropolitan residence, and year of diagnosis.^6–8 Because SEER-Medicare data do not provide individual-level data on income and/or education, we used census tract data and substituted ZIP code–level data when census tract data were not available.²⁰ We grouped median household income and percentage of adults with less than a high school education into quintiles within registry. We defined comorbidity using Klabunde's modification of the Charlson comorbidity index (CCI).²¹

Analyses

We examined sociodemographic and tumor characteristics by age at diagnosis (67 to 69, 70 to 74, 75 to 79, 80 to 84, 85 to 89, and ≥ 90 years), and we examined receipt of treatment by age at diagnosis and stage using the Mantel-Haenszel test of trend. Because of the large sample size, we knew a priori that even small differences in characteristics among age groups would achieve statistical significance; however, we were most interested in trends by age. We additionally examined the proportion of women who were treated with BCS and RT or mastectomy since these treatments are considered standard and equally effective for early-stage breast cancer.²² Using multinomial logistic regression, we examined the effect of age and comorbidity on receipt of treatments for stage I and II disease separately, adjusting for sociodemographics, tumor characteristics, and year of diagnosis. Since few women did not undergo surgery (n = 843; 1.7%), we did not include “no initial surgery” as a treatment option in these analyses. A category of “missing” was included for each covariate in the models.

To determine the impact of age at diagnosis on breast cancer death, we conducted multivariable Cox proportional hazards regression adjusting for sociodemographic and tumor characteristics, year of diagnosis, initial treatments received, and comorbidity. We censored observations of women alive when follow-up ended. We further tested for interactions between treatment and age at diagnosis on breast cancer mortality. To test for residual confounding, we examined the impact of initial treatment on non-breast cancer survival and overall survival.²³ We present the results for non-breast cancer survival since results were similar. We further examined the impact of chemotherapy on breast cancer survival for the subset of women with ER-negative and lymph node–positive tumors adjusting for all covariates.

We performed sensitivity analyses to examine the robustness of our findings. First, we reassessed the impact of treatment on breast cancer survival with propensity score methods, using the “Greedy” match SAS macro²⁴ to minimize bias related to the nonrandom assignment of treatment. Next, we limited our sample to women with known AJCC stage, known histology, and those without a history of cancer. All statistical analyses used SAS version 9.1 (SAS Institute, Cary, NC). The institutional review board approved this study.

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RESULTS

Average the survival rate can be estimated at about 86%.

Tumor Characteristics

Among women with known tumor grade and progesterone receptivity status, there were no statistically significant differences by age. Differences in ER positivity by age were small (< 5% differences among those with known receptor status). Tumor size increased with age, and the increase was more dramatic after age 80 years. Similarly, the number of women who did not have lymph nodes examined increased with age, and the rate of increase was more dramatic after age 80. Among women who had their lymph nodes examined, those age ≥ 80 years were disproportionately more likely to have positive nodes detected than women age 67 to 79 years.

Initial Treatments

Nearly all women (98.3%) received some surgery for early-stage breast cancer. For women with stage I disease, treatment with BCS + RT declined with age, particularly after age 80 (Fig 1). Mastectomy was the most common treatment among women age 80 to 84 years. Almost all (91.7%) women age 67 to 79 years with stage I disease received mastectomy or BCS + RT compared with 66.8% of women age ≥ 80 years. Among women with stage II disease, mastectomy was the most common treatment regardless of age (Fig 2). However, BCS + RT declined with age. Nearly all women age 66 to 79 years with stage II disease (94.5%) received BCS + RT or mastectomy compared with 76.1% of women age ≥ 80 years. Among women with ER-negative, lymph node–positive disease, receipt of chemotherapy declined significantly with age (Fig 3).

 

Fig 1.

Initial treatment for stage I breast cancer by age at diagnosis. Receipt of treatment differed by age at diagnosis for each stage using the Mantel-Haenszel test of trend (P < .001). BCS, breast-conserving surgery; XRT, radiation therapy.

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Fig 2.

Initial treatment for stage II breast cancer by age at diagnosis. Receipt of treatment differed by age at diagnosis for each stage using the Mantel-Haenszel test of trend (P < .001). BCS, breast-conserving surgery; XRT, radiation therapy.

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Fig 3.

Receipt of chemotherapy among women with estrogen receptor–negative, lymph node–positive, stage I/II breast cancer.

In multinomial logistic regression, women age ≥ 80 years were significantly more likely than women age 67 to 79 years to be treated with mastectomy (odds ratio [OR], 2.1; 95% CI, 2.0 to 2.2) or with BCS alone (OR, 4.2; 95% CI, 4.0 to 4.6) compared with BCS + RT. Women with a CCI of 2+ were more likely to receive mastectomy (OR, 1.3; 95% CI, 1.3 to 1.4) or BCS alone (OR, 1.6; 95% CI, 1.5 to 1.8) than BCS + RT. The effect of age was stronger than the effect of comorbidity on receipt of treatment. Among the subset of women with a CCI of 0, 25.8% of women age ≥ 80 years received BCS alone or no surgery compared with 6.0% of women age 65 to 79 years. No significant interactions were observed between age and comorbidity on types of treatment received.

Survival

Overall, median follow-up time was 5.6 years (interquartile range, 3.3 to 8.7). Few women with stage I (4.5%) or stage II (16.1%) disease died of breast cancer. Among women who died, the proportion who died of breast cancer relative to other causes declined with advancing age (Table 1). However, the risk of dying from breast cancer increased significantly with age for women age ≥ 80 years compared with younger women (Table 2). The risk of dying from other causes was greater than the risk of dying from breast cancer at all ages and stages.

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Table 2.

HR of Death Due to Breast Cancer and Other Causes by Age at Diagnosis and Stage

Women treated with mastectomy, BCS alone, or no surgery experienced worse breast cancer survival than those treated with BCS + RT (Appendix Table A1). However, for women treated with either mastectomy or BCS alone, the risk of dying from breast cancer was similar to the risk of dying from other causes. Women who received no surgery had a substantially increased risk of dying from breast cancer compared with those treated with BCS + RT, and this risk exceeded their risk of dying from other causes. However, few women did not receive surgery. No significant interactions were observed between age and treatment on breast cancer mortality; however, interactions between age (67 to 79 v ≥ 80 years) and types of treatment were significant for non-breast cancer mortality.

Among women with ER-negative, lymph node–positive breast tumors, we found that chemotherapy reduced breast cancer mortality (adjusted hazard ratio [aHR], 0.8; range, 0.6 to 0.96). Since the interaction of age and chemotherapy was significant (P = .03), we performed subgroup analyses. Chemotherapy was associated with a significant reduction in mortality for women age 67 to 79 years (aHR, 0.6; range, 0.5 to 0.8) and an increased risk of mortality for women age ≥ 80 years (aHR, 1.5; range, 0.9 to 2.3) that did not achieve statistical significance. Chemotherapy was associated with improved non-breast cancer survival among all women (aHR, 0.6; range, 0.4 to 0.8).

Sensitivity Analyses

In analyses of women with known AJCC stage, known histologic diagnosis, and no history of cancer, the impact of age, comorbidity, and treatment on survival were similar (data not shown). Overall, our results for the associations between treatment and survival outcomes were also similar using propensity score methods (Table 3).

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Table 3.

HR for Different Breast Cancer Treatments on Breast Cancer Death and Non-Breast Cancer Death

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DISCUSSION

Breast cancer characteristics (eg, tumor grade, histology, hormone receptivity) appear to be similar between women age ≥ 80 years and younger women. However, women age ≥ 80 years receive less aggressive treatment than younger women. Greater comorbidity likely accounts for some of the observed difference; however, among women with a Charlson score of 0, 26% of those age ≥ 80 years did not receive standard treatments (mastectomy or BCS + RT) for early-stage breast cancer compared with only 6% of younger women. We also found that the risk of dying from breast cancer increases significantly after age 80. Our findings suggest that we may be able to identify a subgroup of women age ≥ 80 years who may benefit from more aggressive work-up and treatment of their early-stage breast cancer. Conversely, we may also be able to identify a population of older women on the basis of tumor characteristics, comorbid diseases, and life expectancy who may not need as aggressive treatment. The majority of older women with early-stage disease died from other causes. Future studies are needed to develop tools that can help clinicians appropriately target breast cancer treatments to the oldest women most likely to benefit.

Despite prevailing opinion that breast cancer tumor characteristics are more favorable among older women than younger women, we generally did not find clinically important differences by age at diagnosis for most tumor characteristics. However, the youngest women in our study were older than most women included in other studies.²⁵ It is possible that tumors present with more favorable characteristics with older age but beyond age 67 years, these differences are negligible. Other studies have also failed to show increases in hormone receptor positivity among women age 70 years and older.^14,26 Although we and others²⁷ have found that the proportion of women with positive lymph nodes increased with age, we also found that the proportion of women who had their lymph nodes examined declined substantially with age, which may reflect biased sampling. Clinicians may be choosing to sample only lymph nodes of older women who they suspect will be positive.

Regardless of age, we found that the majority of older women undergo surgery for treatment of breast cancer. Among women with stage I disease, BCS + RT is the most common treatment for women age 67 to 79 years. Mastectomy is the most common treatment for women age 80 to 84 years, which may reflect physicians' attempts to treat older women effectively but without radiation. After age 85, BCS alone is the most common treatment. Among women with stage II disease, mastectomy is the most common treatment for all women, regardless of age; however, BCS alone becomes substantially more common after age 80. Some of the oldest women may be undertreated, while others may be being treated appropriately. Future work should focus on identifying tumor and patient characteristics associated with an improved response to aggressive therapy among the oldest women.

As for the impact of RT on older women's breast cancer survival, we found that older women treated with BCS + RT had the best breast cancer survival. However, these women also had the best overall survival, suggesting that unmeasured factors related to survival affected treatment decisions. Clinical trials show that RT after BCS compared with BCS alone reduces breast cancer recurrence among older women with early-stage disease but does not affect survival.^8,28,29 Since we found that breast cancer mortality increases significantly after age 80 and these women are the least likely to be treated aggressively, our findings suggest that some older women in good health may benefit from more aggressive treatment.

We found that treatment with chemotherapy was associated with a survival benefit for women age 67 to 79 years with ER-negative, lymph node–positive disease, results similar to those in other studies.^6,7 However, chemotherapy tended to be associated with worse breast cancer survival among women age ≥ 80 years. Since few women age ≥ 80 years received chemotherapy, our findings suggest that chemotherapy is reserved for the oldest women with the worst tumor characteristics.

This study has several important limitations. Since this is an observational study, there is potential for selection bias and residual confounding by factors for which we do not have data, such as performance status, social support, and treatment with hormonal therapy. In post hoc sensitivity analyses, we examined the effect of an unmeasured confounder such as hormonal therapy on our estimated aHRs. Assuming that treatment with tamoxifen is more common among women age ≥ 80 years than among younger women³⁰ and that the survival benefit of tamoxifen ranges from 10% to 50% reduction in breast cancer mortality,³¹ we found that our aHRs would decrease by less than 10% if we were able to adjust for tamoxifen use.^32,33 Completion of death certificate data could also differ by age. However, studies have found that coding of cancer on death certificates is accurate, particularly coding of breast cancer death.^34,35 In addition, administrative data may underestimate the prevalence of many chronic conditions. Moreover, we needed to exclude women who had missing claims data, the majority of whom had health maintenance organization coverage. Health maintenance organizations tend to include younger and healthier women, which may mean that our sample of women age 67 to 79 years may be older and in poorer health than the overall population. However, this would bias our comparisons between the oldest-old and younger-old toward the null. AJCC staging was modified in 2003 such that women with four or more positive lymph nodes are now classified as stage III. However, only 4.7% of women in our sample had four or more positive nodes. Changes in staging had no effect on women classified as stage I. Finally, although socioeconomic status data were community level, studies have demonstrated moderate associations between individual and aggregate socioeconomic characteristics.²⁰

In summary, breast cancer characteristics are similar among women age ≥ 80 years and younger women. However, women age ≥ 80 years receive less aggressive treatment and are more likely to die from breast cancer. Future studies should focus on identifying tumor and patient characteristics that can be used to help target breast cancer treatments to the oldest women most likely to benefit.

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AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

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AUTHOR CONTRIBUTIONS

Conception and design: Mara A. Schonberg, Edward R. Marcantonio, Rebecca A. Silliman, Ellen P. McCarthy

Financial support: Mara A. Schonberg