2 studies looking speciﬁcally at cancer screening in the elderly. The US Preventive Services Task Force (USPSTF) recom- mends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older [13]. Despite this, however, mammography was noted to be used 72% as adjunct to clinical examination in these older women and only around 30%–38% in women over 80 with occult disease [14]. These suggest that mammography was not largely used for screening purposes in the elderly patient with breast cancer [14]. Knowing that around 77% of deaths attributed to breast cancer are in women older than 55 years of age, it is truly interesting to note that there is an observed age-related diﬀerence in treatment and screening for breast cancer. The study intend to determine whether treatment of and screening for breast cancer in the elderly in a community hospital is appropriate. Improved treatment of older patients with breast cancer is of paramount importance if we are to properly address the growing number of cases and deaths due to breast cancer. 2. Methods The investigators identiﬁed the patients in the study using the American College of Surgeons Committee on Cancer- accredited tumor registry database of The Brooklyn Hospital Center. Patients between the years 1989–1999 were included in the study if they were older than 70 years old at the time of breast cancer diagnosis. The patients were then subsequently divided into three age subgroups: 70–74, 75– 79, and ≥80, roughly corresponding to the age categories used in the geriatric population—the young old (often 65–74 years), the middle old (75–85 years), and the very oldest old (≥95 years). The following information for each subgroup were gathered from the registry: size, grade, histologic type of tumor, complete staging, estrogen receptor status, type of surgical procedure done, type of adjuvant therapy given, and survival data 5 years after diagnosis. The Pearson Chi- square test was used to compare patient characteristics and types of treatment between patient groups. A P value of 0.05 was designated as being signiﬁcant. The protocol was approved by The Brooklyn Hospital Center’s Institutional Review Board (IRB). 3. Results There were a total of 393 female patients (age over 70 years) treated for breast cancer at the Brooklyn Hospital center between January 1989 and December 1999 that were divided into 3 diﬀerent subgroups. There were 151 patients (38%) in the 70–74 years old group, 101 patients (27%) in the 75–79 years old groups, and 141 patients (36%) in the >80 years old group. Majority of our patient population was non-Hispanic blacks in all age groups (63%, 65%, and 52%), followed by Hispanics (26%), then white non-Hispanic (11%) and Asians (3%). The characteristics of the patients identiﬁed through the tumor registry are outlined in Table 1. Infor- mation on whether the patients presented with a palpable International Journal of Breast Cancer breast mass or were diagnosed based on mammography, as well as information on the patients’ functional status and comorbidities were not available in the tumor registry database. There was no signiﬁcant diﬀerence in the tumor size for all age groups (median size was 3.0 cm). Only 7% of all patients have a tumor size of <1.0 cm (nonpalpable). Thirty-nine percent of patients diagnosed were designated as having Stage II disease. Stage IV disease accounted for 3% of total cases. Ductal carcinoma was still the most common histologic type demonstrated in all age groups (69%, 67%, and 62%). Tumor grade was not identiﬁed in roughly half (43%) of these patients. Of those with tumor grading, moderately diﬀerentiated tumors were found to be most predominant. Complete staging was done in 71% of patients. It was noted to be omitted more in women older than 80, but was not statistically signiﬁcant (P ≤ 0.20). About forty-three percent of tumors expressed estrogen receptors. However, about 46% of tumors had unknown estrogen receptor status. Similarly, only 36% of tumors had known positive progesterone status and was unknown in 46%. Surgery was not performed in about 11% of the patients (P ≤ 1). Breast conservation surgery (lumpectomy) was performed in about 42% of all patients, while mastectomy was done in 46% of patients. Of the patients who did not undergo surgery, it was not indicated in the tumor registry database as to whether they were not candidates or whether the patients had refused the procedure. Adjuvant therapy such as chemotherapy, radiation therapy, and hormonal therapy were done in 12%, 25%, and 38%, respectively. The use of chemotherapy was noted to have no signiﬁcant diﬀerence in the three age groups. The same observation was noted for radiation and hormonal therapy with P values of ≤0.10 and ≤1, respectively. However, survival data after ﬁve years of diagnosis showed signiﬁcant diﬀerence between the 75–79 and ≥80 age groups (P ≤ 0.001) as well as that of the 70–74 and the ≥80 age groups (P ≤ 0.001). Overall ﬁve-year survival was only 14% for the ≥80 age group, compared to that of 32% and 35% for the 70–74 and the 75–79 age groups, respectively. No signiﬁcant diﬀerence was noted between the 70–74 and the 75–79 age groups in terms of ﬁve-year survival (P ≤ 1). The type of therapy, if any, in addition to either mastec- tomy or lumpectomy was likewise analyzed from the tumor registry database and presented in Table 2. For patients who underwent mastectomy, there was note of a trend to oﬀer adjuvant treatment to the younger cohort (70–74 versus ≥80 years old). However, the diﬀerence was not statistically signiﬁcant (P ≤ 0.20). Chemotherapy and radiation therapy were given more to younger patients. That of hormonal therapy was noted to be the same. For those patients who underwent lumpectomy, the opposite trend was observed. Patients who were older were given more adjuvant treatment than the younger age group although again, the diﬀerence did not have statistical signiﬁcance. Of note is that there were no patients given chemotherapy in those who had lumpectomy in the 70–74 age group, whereas about 20% received such therapy in the 80 and older group (P ≤ 0.01). The results in Table 3 showed that 47% of patients found to have positive lymph nodes received some form of