Treatment for breast cancer in patients with Alzheimer's disease.
OBJECTIVE
To report use of breast cancer treatment (surgery, radiation, and chemotherapy) by patients with Alzheimer's disease (AD).


METHODS
Retrospective cohort study.


METHODS
Surveillance, Epidemiology, and End Results (SEER) is a population-based cancer registry covering 14% of the U.S. population.


METHODS
Fifty thousand four hundred sixty breast cancer patients aged 65 and older, of whom 1,935 (3.8%) had a diagnosis of AD before or up to 6 months after cancer diagnosis.


METHODS
Diagnosis of AD was taken from International Classification of Diseases, Ninth Revision, diagnostic codes accompanying Medicare billing claims between 1992 and 1999. The SEER program reported surgery and radiation. Chemotherapy was taken from Medicare billing records.


RESULTS
Subjects with AD were diagnosed with breast cancer at later stages, when tumors were larger and the likelihood of lymph node involvement had increased. Patients with AD had a lower likelihood of surgery (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.46-0.81), radiation (OR=0.31, 95% CI=0.23-0.41), and chemotherapy (OR=0.44, 95% CI=0.34-0.58) than those without AD.


CONCLUSIONS
Overall, AD patients receive less treatment for breast cancer than do comparable female Medicare beneficiaries. Chemotherapy and radiation are administered less frequently to women with AD than to other comparable patients. It is unclear whether suboptimal medical care has an effect on their survival. Further research on the effect of screening and treatment decision-making for these patients is warranted.
Gorin
Sherri Sheinfeld
SS
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. ssg19@columbia.edu
Heck
Julia E
JE
Albert
Steven
S
Hershman
Dawn
D
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D006278:Medicare; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000453:epidemiology / Q000628:therapy; D016017:Odds Ratio; D011960:Receptors, Estrogen / Q000032:analysis; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States
D011960:Receptors, Estrogen