Comorbidities in the Aging Breast Cancer Population: Are Current Assessments Leading to Improved Outcomes?

Extract

Breast cancer is the most common noncutaneous cancer worldwide among a rapidly growing population of women aged 65 years or older. More than one half of the 2.6 million women who are breast cancer survivors and of the 207 000 women newly diagnosed with breast cancer each year in the United States are older than 65 years. Survival and all-cause mortality clinical outcomes among breast cancer patients are influenced by competing mortality associated with age, race/ethnicity, and comorbid diseases ( 1 ). Important questions concerning the development of other diseases commonly associated with aging and coexisting with breast cancer are challenges to its management.

In this issue of the Journal, Patnaik et al. ( 2 ) use Surveillance, Epidemiology, and End Results and Medicare data to determine the effect of 13 distinct comorbid conditions on overall survival and all-cause mortality among 64 034 breast cancer patients aged 66 years or older from 1992 to 2000. Inpatient and outpatient visits were reviewed to determine comorbidities 1 year before and 30 days after breast cancer diagnosis and to capture comorbidities not associated with cancer treatment. At the time of diagnosis, relationships between comorbidities and survival were determined by a modified and weighted Charlson Comorbidity Index Score. Comorbidities with the highest prevalence observed by the authors in the study population included previous cancer, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and stroke. When patients were stratified by specific comorbidity, all 13 comorbidities were associated with a statistically significant decreased overall survival and increased mortality compared with patients who had no comorbidities. Also, Patnaik et al. ( 2 ) show that stage I breast cancer patients aged 66–74 with comorbid conditions had survival rates similar to patients with stage II cancers who did not have comorbidities; a similar trend was also found among older patients aged 75–84 years and 85 years or older.