Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M
School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
Br J Cancer. 2007 Apr 23;96(8):1197-203. doi: 10.1038/sj.bjc.6603709. Epub 2007 Mar 27.
Evidence suggests that compared to younger women, older women are less likely to receive standard management for breast cancer. Whether this disparity persists once differences in tumour characteristics have been adjusted for has not been investigated in the UK. A retrospective cohort study involving case note review was undertaken, based on the North Western Cancer Registry database of women aged > or =65 years, resident in Greater Manchester with invasive breast cancer registered over a 1-year period (n=480). Adjusting for tumour characteristics associated with age by logistic regression analyses, older women were less likely to receive standard management than younger women for all indicators investigated. Compared to women aged 65-69 years, women aged > or =80 years with operable (stage 1-3a) breast cancer have increased odds of not receiving triple assessment (OR=5.5, 95% confidence interval (CI): 2.1-14.5), not receiving primary surgery (OR=43.0, 95% CI: 9.7-191.3), not undergoing axillary node surgery (OR=27.6, 95% CI: 5.6-135.9) and not undergoing tests for steroid receptors (OR=3.0, 95% CI: 1.7-5.5). Women aged 75-79 years have increased odds of not receiving radiotherapy following breast-conserving surgery compared to women aged 65-69 years (OR=11.0, 95% CI: 2.0-61.6). These results demonstrate that older women in the UK are less likely to receive standard management for breast cancer, compared to younger women and this disparity cannot be explained by differences in tumour characteristics.
有证据表明，与年轻女性相比，老年女性接受乳腺癌标准治疗的可能性较小。在英国，尚未对在调整肿瘤特征差异后这种差异是否仍然存在进行调查。基于大曼彻斯特地区年龄≥65岁、居住在当地且在1年期间登记患有浸润性乳腺癌的女性的西北癌症登记数据库，开展了一项涉及病例记录回顾的回顾性队列研究（n = 480）。通过逻辑回归分析对与年龄相关的肿瘤特征进行调整后，在所有调查指标上，老年女性比年轻女性接受标准治疗的可能性更小。与65 - 69岁的女性相比，患有可手术（1 - 3a期）乳腺癌的≥80岁女性未接受三联评估的几率增加（比值比[OR]=5.5，95%置信区间[CI]：2.1 - 14.5），未接受初次手术的几率增加（OR = 43.0，95% CI：9.7 - 191.3），未进行腋窝淋巴结手术的几率增加（OR = 27.6，95% CI：5.6 - 135.9），未进行类固醇受体检测的几率增加（OR = 3.0，95% CI：1.7 - 5.5）。与65 - 69岁的女性相比，75 - 79岁的女性在保乳手术后未接受放疗的几率增加（OR = 11.0，95% CI：2.0 - 61.6）。这些结果表明，在英国，与年轻女性相比，老年女性接受乳腺癌标准治疗的可能性较小，且这种差异不能用肿瘤特征的差异来解释。
