In general, cancer incidence increases with age, reflecting the cumulative genetic changes to the cells that occur over time. More significantly, cancer mortality generally increases with age, largely due to poorer tolerance of the effects of cancer and cancer therapies.
Recently, there has been increasing recognition of the growing importance of cancer as a problem among the elderly. Older cancer patients are different from younger ones in the following ways:
- There are considerably more differences in the older population than the younger one; as such, there is a greater need for individualization in the treatment approach.
- Older people tend to have less functional reserve than younger ones, thereby lowering their tolerance of cancer therapies.
- Older people are more likely to have coexisting medical conditions that negatively impact on their ability to withstand the deleterious effects of cancers or their treatment.
- Older people tend to have multiple somatic symptoms, and this sometimes hinders an early diagnosis of cancer.
- Older cancer patients react to cancer drugs differently from younger patients, and are also more prone to adverse drug interactions.
- Older cancer patients may have different personal goals for cancer therapy than younger patients.
- Social support and maintenance of independence are more pertinent issues to the older cancer patients; as such, their management often requires a multidisciplinary approach.
The oncologist attending geriatric cancer patients must utilise both the art and the science of medicine in dealing with the diverse problems arising from this very challenging patient population.
Which cancers are common among elderly women?
The commonest cancers among elderly Singapore women are colorectal cancer, lung cancer, breast cancer and stomach cancer. They account for 21%, 15%, 10% and 9% respectively of all cancers among females aged 65 years and older. This contrasts sharply with the younger Singapore women in whom breast cancer is clearly the commonest cancer.
While most lung cancers among males are causally related to smoking, a significant portion of nonsmoking women are afflicted with lung cancer. Most of these women developed a particular subtype of lung cancer — adenocarcinoma, a gland-forming type of lung cancer. Of concern is the observation that the incidence of adenocarcinoma among nonsmoking females is rapidly rising in Singapore and in some other Asian countries. The exact cause for this trend is unclear, although theories have been put forward, including passive smoking, exposure to superheated cooking oil, and possible underlying genetic changes in these women.
Breast cancer incidence in Singapore is between the high rates of Western populations and the low rates in many parts of Asia. The risk of breast cancer rises with age to peak in the age group 45-49 years, with a plateau over the older age groups. This is somewhat different from many cancers, the risk of getting which continue to increase with age. There is emerging evidence to suggest that breast cancer among Singapore women may be occurring at an increasingly younger age than their Western counterparts.