Introducing a New Series: Cancer in Older Adults

Steven R. Gambert, MD, AGSF, MACP Editor-in-Chief, Clinical Geriatrics

This issue of Clinical Geriatrics marks the beginning of a new series of articles focusing on Cancer in Older Adults. Our first article in this series is titled “Challenges in the Diagnosis and Treatment of Breast Cancer in the Elderly.” Future issues of Clinical Geriatrics will feature articles on cancer and aging, colon cancer, prostate cancer, hematologic malignancies, cancer screening and prevention, and palliative care and hospice.

The incidence of cancer increases greatly with age. It has been reported that age 68 is the median for the occurrence of all types and sites of cancer. The incidence of cancer in older adults is over 10 times that for younger persons, with more than 60% of all cancers occurring in persons over the age of 65. Over 70% of deaths due to cancer are in persons over age 65, and the number of cases in persons over age 75 is expected to triple by 2050. Lung cancer is currently the most common fatal cancer in both men and women over the age of 60 years, representing over 30% of all cancer deaths for this population. Breast cancer and colorectal cancer are the second and third most common causes of cancer-related deaths in elderly women; colorectal and prostate cancers are the second and third most common causes of cancer-related deaths in elderly men.

Unfortunately, it seems as though few families in the United States have not been touched in some way by the ravages of breast cancer in a mother, wife, sister, daughter, or other family member. The lifetime incidence of breast cancer in women is similar in magnitude to that of prostate cancer in men. The incidence of breast cancer increases up to age 80 and plateaus between ages 80 and 85 years.

While we are able to screen for breast cancer better than ever before with the use of newly developed and more sensitive technology, the high number of older women presenting with advanced stages of breast cancer continues to remain a challenge. Not all older women choose to follow the recommendations for breast cancer screening, and, unfortunately, many will pay the price for this choice. Few of the expert guidelines available consider functional status or comorbidities when advising about breast cancer screening in older women.1 A method combining age with functional status/comorbidities in helping patients and their providers decide whether to access this Medicare-funded screening test would be the most beneficial. While treatment aims for a “cure” in the early stages of breast cancer, more advanced cases are commonly referred to as a “chronic illness” needing to be treated as problems arise.

It is important that older women not become complacent just because they have had normal mammograms in the past. Some women give up on their yearly mammograms because the lesions that have been found and biopsied time and again were all reported to be “negative.” We hear women saying that the screening was both painful and frightening, and one they chose not to repeat after so many “false” tests. It is important to re-emphasize to our patients that the risk of a new problem remains despite years of negative results and negative biopsies. The earlier a cancer is detected, the better the chance for a “cure,” regardless of one’s age.

We have a long way to go until breast cancer is no longer the feared problem that it is today for all women; nevertheless, we have ways of finding cancers earlier than ever before, and through new treatments we anticipate more successful outcomes. I hope you will enjoy reading the first article in this clinically useful and stimulating series. We invite your comments and suggestions.

Dr. Gambert is Professor of Medicine and Associate Chair for Clinical Program Development, Co-Director, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Director, Geriatric Medicine, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, and Professor of Medicine, Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.