Research Opportunities in Health Psychology and Aging 501Cancer Prevention and Aging
In general, there appears to be an increase in cancer screening
with age to around 70 followed by a decline. For example,
data from the 1990 National Cancer Institute (NCI) Mam-
mography Attitudes and Usage Survey indicated that 40% of
women in their forties reported having an annual mammo-
gram, compared to only 18% of women over the age of 70.
Therefore, the situation for older women seems especially
perilous; not only do they have a greater risk of developing
breast cancer, but it seems they have less chance of having
the cancer detected. These patterns are unfortunate given
that the incidence of cancer increases with age.
Cancer Diagnosis and Aging
Researchers have found that psychological impact of cancer
diagnosis is inversely associated with age for at least both
prostate and breast cancer patients (Cordova et al., 1995;
McBride, Clipp, Peterson, Lipkus, & Demark-Wahnefried,
2000). Cancer diagnosis may have less psychological impact
for older patients, because illness may be regarded as a natural
part of aging and, thus, an •on-timeŽ event. Younger age at di-
agnosis may also be indicative of greater family risk of cancer,
which may increase the psychological impact of the diagnosis.
Cancer Progression, Recurrence, and Aging
A wide range of psychosocial factors has been associated with
the course of established cancer, though this literature is re-
plete with inconsistencies (Fox, 1998). Some studies have
suggested, for example, that breast cancer patients• reactions
to the stress of diagnosis characterized by a •“ghting spiritŽ
predicted the course of disease (e.g., Greer, Morris, Pettingale,
& Haybittle, 1990). One study, however, reported that among
578 women with breast cancer, an increased risk of relapse
or death over a “ve-year period was associated with greater
helplessness/hopelessness but was unrelated to stoicism, de-
nial, or “ghting spirit (Watson, Haviland, Greer, Davidson, &
Bliss, 1999). These inconsistencies may be because of the
heterogeneity in the samples of patients studied (e.g., mixed
cancer types and stages), psychosocial variables assessed,
psychosocial interventions tests, and the study designs,
control variables, and analytic procedures used (Garssen &
Goodkin, 1999). Cancer recurrence is devastating, and the
magnitude of distress is even greater than that found with
the initial diagnosis.
Cancer Treatment and Aging
Breast cancer is of particular concern to older women be-
cause age is positively correlated with increased incidence
and mortality. Women ages 65 to 69 have an annual incidence
rate of 350 per 100,000, and for women age 85 years or older,
the incidence climbs to 412 per 100,000. Over half of all
breast cancer deaths occur in women who are over 65 years
old (Morbidity and Mortality Weekly Report, 1996).
Postmenopausal breast cancer patients frequently have
one or more preexisting comorbid conditions at the time of
diagnosis (e.g., heart disease, chronic obstructive pulmonary
disease, hypertension, diabetes, arthritis; Yancik et al., 2001).
Thus, the prediagnostic health status of cancer patients in
middle and later age groups may affect tumor prognosis
and treatment decisions. Studies have shown that age and co-
morbidity strongly in”uence therapeutic decisions and are as-
sociated with less aggressive cancer therapy (Newschaffer,
Penberthy, & Desch, 1996; Silliman, Guadagnoli, Weitberg,
& Mor, 1989; Silliman, Troyan, Guadagnoli, Kaplan, &
Green“eld, 1997). Furthermore, much of the data on cancer
treatment ef“cacy comes from clinical trial investigations
that tend to exclude breast cancer patients age 70 years and
older who are likely to have preexisting diseases and other
health limitations (Hutchins, Unger, Crowley, Coltman, &
Albain, 1999).
Elderly women are offered axillary node dissection,
chemotherapy, and reconstruction signi“cantly less often than
their younger counterparts (Chu et al., 1987; Newschaffer
et al., 1996; Samet, Hunt, Key, Humble, & Goodwin, 1986;
Silliman et al., 1989). The 1990 National Institute of Health
(NIH) Consensus Development Conference on the treatment
of early-stage breast cancer concluded that axillary node dis-
section was preferred treatment for all women with Stage 1
and Stage II disease regardless of age, although few trials
included women over age (NIH Consensus Conference:
Treatment of Early Stage Breast Cancer, 1991). Only 62% of
a large sample of breast cancer survivors age 65 years and
older met guidelines for annual mammography, and women at
greatest risk for disease recurrence (those treated with breast-
conserving surgery) were least likely to receive follow-up
mammography (M. Schapiro, McAuuliffe, & Nattinger,
2000).Cancer, Aging, and SurvivorshipWhile much research has been conducted examining the rela-
tionship between coronary artery disease and age, much less
has been reported of the interaction between cancer and aging
and subsequent survivorship. The term survivortypically
refers to individuals surviving at least “ve years, as the prob-
ability of late recurrences declines signi“cantly after that
time for most sites. Survival of persons diagnosed with
cancer is improving. Today, almost 60% of adults diagnosed