OBJECTIVES

Women with multiple comorbidities and impaired physical functioning have competing health needs with respect to preventive care, including screening for early detection of breast cancer. We aimed to determine associations between physical functioning and frailty with risk of locally-advanced breast cancer.

METHODS

We conducted a retrospective cohort study of women 65 years and older diagnosed with first primary stage I-III breast cancer using the Surveillance, Epidemiology and End Results Medicare Health Outcome Survey Data Resource. Women completed at least one survey within two years prior to breast cancer diagnosis. Physical health-related quality of life was measured using Veterans RAND 12 Item Health Survey scales; frailty was determined by calculating deficit-accumulation frailty index (DAFI) scores. Multivariable modified Poisson models with robust standard errors were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for risk of locally-advanced (stage III) breast cancer compared to early-stage (I-II) breast cancer.

RESULTS

Among 2,411 women with a median age of 75 years at breast cancer diagnosis, 2,189 (91%) were diagnosed with incident stage I-II breast cancer and 222 (9%) were diagnosed at stage III. Compared to women with early-stage disease, women with locally-advanced disease had lower physical component scores (37.8 vs. 41.4) and higher DAFI scores (upper quartile 28% vs. 24%). In multivariable models, greater frailty was not associated with increased risk of locally-advanced disease. However, worse physical function subscale scores (1^st vs. 4^th quartile; RR 1.56, 95% CI 1.04-2.34, P=0.03) were associated with a higher risk of locally-advanced breast cancer.

CONCLUSIONS

Our findings suggest that poor physical functioning may be associated with diagnosis of later-stage breast cancer. Providers discussing the risks and benefits of breast cancer screening among older women should include consideration of frailty and physical functioning.