Wright JD, Gibb RK, Geevarghese S, et al: Cervical carcinoma in the elderly. Cancer 2005;103(1):85-91.
Granai CO: That certain age. Cancer 2005;103(1):5-9 (editorial).
Age is an important factor for the allocation of treatment and for survival for patients with invasive cervical cancer. Between January 1986 and July 2003, 1582 patients with invasive cervical cancer were evaluated and managed at a hospital in Missouri, including 197 patients age > 70 years. Early-stage disease occurred in 44% of the women > 70 years compared to a 60% incidence in women < 70 years (P <0.0001). Even with adjustment for disease stage, younger patients were more likely to undergo surgery and older patients were more likely to receive primary radiotherapy (P <0.0001). The elderly women were 9 times more likely than the younger women to forego treatment (3.6% vs. 0.4%; P <0.0001). This study adds to others that suggest elderly patients with malignancies are treated differently, and often have inferior outcomes, compared with younger patients. Several factors contributed to these differences, including the presence of more severe coexisting disease in elderly patients, which biased against radical surgery. Other studies have shown that when adequate treatment is delivered, both tumor control and survival in elderly women are similar to younger women. Complication rates after hysterectomy and radiation may be slightly greater in the elderly than in younger women, but are in an acceptable range. When an elderly woman has cervical cancer, or any cancer, the authors propose that the first question to ask is "what is the optimal treatment for this problem?" Secondary questions related to a specific patient's physiologic risk factors should then be considered in sequence to reach a therapeutic decision. Geriatric patients often tolerate treatment well, and aggressive therapy for patients with cervical cancer should not be withheld based on age alone.