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November 13, 1987

Age-Related Breast Cancer Therapy

Author Affiliations

Miami Beach, Fla

Miami Beach, Fla

JAMA. 1987;258(18):2526. doi:10.1001/jama.1987.03400180060012

To the Editor.—  In the May 22/29 issue of JAMA, Greenfield et al1 report inappropriateness in the treatment of elderly patients with breast cancer, both with and without comorbidity. The article implies that the attending physicians were less than ideally aggressive in management. I write to compliment them on their study and to raise two points.First, what part did the patient herself, or her family, play in the rejecting of "appropriate" aggressive management; could the patient, or her family, have expressed the view that the patient was "too old?"Second, I challenge the study's breast cancer criteria map, which defined as appropriate an axillary dissection in elderly patients, including those too frail for effective chemotherapy.In its 1985 Consensus Development Conference statement, the National Institutes of Health agreed that chemotherapy was not appropriate in the postmenopausal patient.2 Although medical oncologists in the United States occasionally do use