Older Women Without Breast Cancer May Inappropriately View Certain Treatment Options as Negatively Impacting Prognosis

Older women without hormone receptor (HR) positive breast cancer are still experiencing overtreatment despite national recommendations to omit, due to lack of reframing prognosis and education on treatment risks, according to a study published in Jama.

“Positive reframing of recommendations to avoid (sentinel lymph node biopsy) and radiotherapy may be a strategy to reduce overtreatment while maintain patient’s autonomy” the study authors wrote. “Although patient preferences for (sentinel lymph node biopsy)could partially explain high rates of (sentinel lymph node biopsy) use nationally, persistent use of adjuvant radiotherapy may be associated with factors related to guidelines, health professionals, incentives or resources, and capacity for organizational change.”

Women aged 70 years and older diagnosed with HR-positive breast cancer often have a positive prognosis, but due to age and comorbidities (presence of two or more conditions), they suffer from a higher risk of adverse events related to their treatment, Although findings from other studies demonstrated it may be safe for women 70 years and older to forego routine treatments including postlumpectomy radiotherapy (radiation therapy after undergoing lumpectomy for breast cancer) and sentinel lymph node biopsy (a test to determine whether cancer spread to the lymphatic system), they continue to be used at high rates.

Clinicians may associate overtreatment with patient preference, although evidence suggests older may prefer less aggressive treatment.

To understand this, researchers conducted a study using phone interviews with 30 women (median age,72 years) age 70 years or older without a breast cancer diagnosis from October 2019 to January 2020.

During the interviews, the participants were asked about hypothetical scenarios such as they are receiving a diagnosis of low-risk HR-positive breast cancer and receiving treatment options in accordance with current guidelines. Treatment options include chemotherapy, surgery, sentinel lymph node biopsy and lumpectomy.

Women in the study believed that guidelines based on age were appropriate regarding lowering the risk of reoccurrence and potentially increasing frailty in older patients. Participants also stated that the guidelines should not apply to older healthy women who have a long-life expectancy. In additions, some participants did not understand that deescalating treatment in older patients is a favorable prognosis rather than a poor one.

Twelve women (40%) reported that they would undergo a sentinel lymph node biopsy, as it seemed like a low-risk procedure and it would provide peace of mind. Most participants (22 participants or 73%) reported they would rather omit postlumpectomy radiotherapy from their treatment due to risks, inconvenience, and lacking benefits.

“Our study found that although most older women accepted the premise of age-based treatment strategies, there were several competing factors, including current health status, threats to quality of life, need for patient autonomy and uncertainty about research informing current guidelines that would influence their decision making they received a diagnosis of breast cancer,” the study authors wrote.

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