DM's breast cancer. Age discrimination??? Medics help please

[RapunzelsRealMom]

I really hope someone can help me with this. I have looked through so many different medical papers and articles but have found conflicting information.

For a bit of context:
DM, 74, has recently been diagnosed with breast cancer (grade 2, hormone positive). She is a 'young' and very fit 74 - never smoked, rarely drinks, ideal weight, goes to gym 3 times per week, plays golf.
Last week, she had a lumpectomy and all her lymph nodes removed on one side.
Since her diagnosis, she has been consistently told she would get chemo and radiotherapy.
Today, she had her follow up appointment and the surgeon told her she now probably won't get chemo because of her age. She was vague and sort of implied that it may be because the efficacy of treatment declines in old age but she also implied that it was just an age-issue (i.e., her life is not as valuable as a younger woman). Please note, neither of these reasons were explicitly given, however, DM got the impression from her that it could be either.

Next week we will go back to discuss the treatment and I need to be fully prepared with facts and need to recognise if they are discriminating against DM because of her age.

So, someone please tell me: are the NHS (in Scotland, if that makes any difference) failing to give chemotherapy to older patients purely because of their age? Or is chemotherapy genuinely less effective in older patients?

I don't know anything about medical stuff, however my mum has recently been diagnosed with ovarian cancer and she is 75 (also a very young 75) they did talk about chemotherapy with her (turns out she doesn't need it but they were going to give it if she did)

I hope you get this sorted out. If it is going to give her the best chance of getting rid of the cancer then they should absolutely do it, whether she's 74 or 44.

With her age, the point is that it in her best interests not to have the chemo. Rather than discriminating against her on age grounds, they are treating her according to her age.

They probably assessed that she is already cancer free and that chemo is needless. This definitely does depend on age.

If she saw her surgeon, that isn't the actual oncologist. She'll see an oncologist and that person will ultimately give her treatment options, the surgeons opinion is a guide.

And if they don't want to give chemo, it's a good thing.

It's less necessary in older patients.

I'm not a medic, but I know that they do treat cancers differently according to the age of the patient. It's not so much that a younger person's life is more valuable, more that a younger person might be able to cope with an invasive/gruelling treatment better than an older person. Put another way, you can give an older person a course of aggressive chemotherapy- but that might reduce her quality of life so much that it wouldn't be considered a successful outcome.

Was anyone with her to hear this, not that she has misheard but perhaps not taken all the information in. DM , who was older than yours, had lumpectomy and radiotherapy iirc. But treatment will vary on type and stage.

The results of her surgery will be discussed at a multidisciplinary meeting. The likelihood is that the surgical results were better than they expected and that the benefit of chemo is too low to make it worth giving. She’d be suffering the side effects with no significant benefit to her.

My 70-something aunt definitely did have chemo for her breast cancer so it’s not a hard and fast rule in England. As you get older the risk benefits calculation does change for more aggressive treatments but it’s probably worth her having an advocate for her next consultation to make sure that any assessment is based on her personal circumstances and individual health and life expectancy rather than a blanket population-wide judgement.

This article is interesting if perhaps one-sided

My DF got chemo and radiotherapy at 69 without any issues whatsoever. He is now 70 and the Consultant is happy to continue treatment cycles and has made no reference to his age whatsoever.

The chemo was also exceedingly effective on his Lung Cancer, turning him from a diagnosis of a couple of months to 2 and half years with his Grandson that we weren't expecting.

Therefore I find it hard to believe they are refusing necessary treatment based on age.

It isn't age discrimination to recognise that breast cancer in older women has a different progression, and different treatment response, than in younger women. It's trying to tailor treatment to the individual. My grandma had breast cancer in her 70s. She had minimal treatment. 10 years later, she still had breast cancer, but as anticipated, it was something else completely unrelated that killed her. Aggressive chemo would probably have finished her off years earlier.

Thank you all for your input. I accept the reasoned responses.

One thing I should have said: the surgeon said - we'd give chemo to a younger woman as we'd expect her to live another 30 years. That's what made DM feel that it was purely down to her age and not other factors. It may be unrealistic, but she could live 20 or more years, given her healthy lifestyle.

And to answer someone's question, her DH was there to advocate and his thoughts are the same as hers.

Chemo is very hard on the body, it takes a lot out of a person to recover from chemo. More treatment is not always the best treatment for future good health. x

My 80+ DF has recently been diagnosed with breast cancer and has been prescribed Tamoxifen. It's brutal and making him very unwell, sadly he isn't a good candidate for a mastectomy.

Is your mother getting hormonal therapy? Chemo is quite a blunt tool and tends to be most effective in grade 3 cancers because it targets rapidly dividing cells. It is true that younger women get chemo more often, but they are more likely to have grade 3 disease or be Her2+ or triple negative.

Hormonal treatment cuts off the supply of hormones that feed ER+ cancer and can be more effective than chemo at preventing recurrence. I’m not sure how many lymph nodes tested positive for cancer, but you could ask for an OncoDX test which tests the tumour biology and gives a clearer indication of if chemo will be of benefit.

A friend of my mother’s had chemo at 79 but her cancer was Her2+ and Herceptin is only licensed alongside taxane based chemo. She was given 75% of the full dose and tolerated it well.

It was horrible for your mother to feel written off because of her age though. Hopefully she will make a good recovery. I hope you get some answers next week. If your mum is on Facebook there are some good support groups, I quite like BRiC - building resilience in breast cancer.

BigBird i have not heard if she is getting hormone therapy. It has not been mentioned so I assume not.

To be honest, my mum is very capable and independent and I've stepped back for her to deal with this herself (with her lovely DH). Today, it has occurred to me to step up a little and attend these appointments with her.

Your post has given me a lot to ask and read up about. Thank you

My mum had what sounds very similar to your mum's diagnosis 5 years ago. She had a mastectomy and then radiotherapy. Her treatment was defined by a multi-disciplinary team and age was a factor considered. As others have said though, age is a factor but not for reasons of discrimination. My understanding is that the progression of the disease in older patients can be quite different to that of younger patients.

I found the team that looked after my mum to be really good at explaining, I learned how complex the disease is and the importance of a tailored approach. I obviously don't know your mum's case but I believe the team will have her best interests at heart.

I hope all goes well.