Advanced age and adjuvant tamoxifen prescription in early-stage breast carcinoma patients.
BACKGROUND
Adjuvant tamoxifen is recommended for all women with estrogen receptor-positive breast carcinoma without regard for age. We investigated age-dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older.


METHODS
We studied 92 women diagnosed at four U.S. sites with primary, early-stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85-92 years of age with those received by women 80-84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed.


RESULTS
Before adjustment, patients 85-92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80-84 years of age (RR = 0.72, 95% CI 0.57-0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58-0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59-0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed.


CONCLUSIONS
Given the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality.
Blackman
Sarah B
SB
Geriatrics Health Services Research Unit, Boston Medical Center, Boston, Massachusetts 02118, USA.
Lash
Timothy L
TL
Fink
Aliza K
AK
Ganz
Patricia A
PA
Silliman
Rebecca A
RA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D018579:Patient Selection; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000378:metabolism; D013629:Tamoxifen / Q000627:therapeutic use*; D014481:United States
D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D013629:Tamoxifen