乳腺癌患者的年龄因素不足以单独决定她是否应该接受包括乳房肿瘤切除术和放射线治疗的标准乳房保留治疗。但是，根据一项发表在4月1日的爱思唯尔期刊《国际放射线、肿瘤学、生物学、物理学杂志》（该杂志为美国放射治疗学和肿瘤学学会的官方期刊）上的研究，一旦存在其它健康问题，则应该根据个体患者的年龄和共并症的类型来选择治疗手段。
妇女患乳腺癌的风险随着年龄的增长而增加。根据国际癌症协会的统计预测，年龄在75岁到79岁之间的妇女有着最高的乳腺癌诊断率，每10万个人中有497个病例。在这一年龄段的妇女除了癌症以外大都还有着其他的健康问题。根据《临床流行病学杂志》的1999年妇女健康年龄研究，大多数年长的乳腺癌患者有至少一种其他疾病，超过一半的年龄大于65岁的患者有至少3种其他健康问题。
这项研究由宾夕法尼亚大学医学院的放射线肿瘤学系、生物统计和流行病学系、医学系和老人病学部合作进行，目的是确定相对于没有共并症的患者，这些其他健康问题对接受标准治疗的乳腺癌患者的影响，并确定年龄是否可以成为否决一些标准治疗手段的因素。
大多数用来比较放射线使用与否的乳房保留手术效果的随机试验结果都表明，使用放射线更有利。但是试验中的大多数手术都把70岁以上的患者排除在外，因此关于放射线对老年妇女的影响并没有很多数据。
在1979年和2002年之间，238名70岁以上、患有一期或二期浸润型乳腺癌的患者，接受了乳房保留治疗，她们的结果分年龄段和共病症进行了比较。大多数被研究的患者患有轻度的共病症。
研究人员发现，被研究对象死于乳腺癌的比率与各个年龄段没有共并症的患者相近。她们还发现，大多数患有早期乳腺癌和轻度共并症的老年妇女事实上更适合于放射线治疗，并有最小的副作用。
全部病人的术后5年和术后10年的存活率分别为80%和50%。但是，在术后10年的病人更多地死于并发症而不是乳腺癌。
美国Moffitt癌症中心放射线肿瘤主任Eleanor Harris说：“医生们需要知道是共病症而不是年龄，应该成为决定老年病人治疗方案的决定因素。在这个领域有种说法认为年长的妇女比年轻的妇女需要较少的治疗，但是我们不应该仅仅因为她们年龄大于70岁而给予不充分的治疗。”（科学网 刘乐/编译）
生物谷推荐原始出处：
（International Journal of Radiation, Oncology, Biology, Physics），doi:10.1016/j.ijrobp.2007.08.059，Eleanor E.R. Harris, Lawrence J. Solin
The Impact of Comorbidities on Outcomes for Elderly Women Treated With Breast-Conservation Treatment for Early-Stage Breast Cancer
Eleanor E.R. Harris M.D.*, , , Wei-Ting Hwang Ph.D.†, Sandra L. Urtishak M.D.*, John Plastaras M.D., Ph.D.*, Bruce Kinosian M.D.‡ and Lawrence J. Solin M.D.*
†Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
‡Department of Medicine, Division of Geriatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
*Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA
Purpose
Breast cancer incidence increases with age and is a major cause of morbidity and mortality in elderly women, but is not well studied in this population. Comorbidities often impact on the management of breast cancer in elderly women.
Methods and Materials
From 1979 to 2002, a total of 238 women aged 70 years and older with Stage I or II invasive carcinoma of the breast underwent breast-conservation therapy. Outcomes were compared by age groups and comorbidities. Median age at presentation was 74 years (range, 70–89 years). Age distribution was 122 women (51%) aged 70–74 years, 71 women (30%) aged 75–79 years, and 45 women (19%) aged 80 years or older. Median follow-up was 6.2 years.
Results
On outcomes analysis by age groups, 10-year cause-specific survival rates for women aged 70–74, 75–79, and 80 years or older were 74%, 81%, and 82%, respectively (p = 0.87). Intercurrent deaths at 10 years were significantly higher in older patients: 20% in those aged 70–74 years, 36% in those aged 75–79 years, and 53% in those 80 years and older (p = 0.0005). Comorbidities were not significantly more common in the older age groups and did not correlate with cause-specific survival adjusted for age. Higher comorbidity scores were associated with intercurrent death.
Conclusions
Older age itself is not a contraindication to standard breast-conservation therapy, including irradiation. Women of any age with low to moderate comorbidity indices should be offered standard breast-conservation treatment if otherwise clinically eligible.
