Integration of Aging and Cancer Research in Geriatric Medicine

r T n HERE is an urgent need for information on cancer in A the elderly population. The paucity of data on agerelated issues and problems at the aging/cancer research interface (i.e., the normal processes of aging and the pathophysiological processes of aging in combination with cancer) make it difficult to provide definitive answers to many questions that arise about cancer in older persons. The National Institute on Aging (NIA) Geriatrics Program has recently formed a new research area in accordance with its program mission to support research and research training directed at the pathophysiology, diagnosis, treatment, and prevention of age-related diseases, degenerative conditions, and disabilities. The fundamental question is, How can the knowledge and techniques developed for cancer prevention, early detection, diagnosis, and treatment be translated into action on behalf of older persons? Americans in the age group 65 years and older are particularly vulnerable to cancer. The greatest single risk factor for the development of cancer is aging. Data from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program for 1990-94 clearly show that cancer incidence and mortality rates increase as a function of age for most major tumors. The age-specific cancer incidence rate is 2265.2 per 100,000 for persons aged 65 and over as compared to 205.6 per 100,000 for those younger than 65 years, an 11-fold difference (1). Mortality rates between these two age groups are 1083.9 (65+) and 72.4 (< 65) per 100,000 population, a 15-fold difference (1). The SEER data show that 60% of all malignancies and 69% of all cancer deaths are in the 65+ segment of the U.S. population (2). Using the median age at initial diagnosis for 12 major tumors, the cancer burden for older persons is aptly illustrated in Table 1. Only three tumor sites have a median age at diagnosis lower than 65 years — female breast cancer (64 years); non-Hodgkin's lymphoma for males (61 years); and ovarian cancer (63 years). These 12 malignancies, selected from the comprehensive list of 66 malignant disease categories registered by the SEER Program for 1989-93, account for over 75% (405,492) of the incident cases (2). The vulnerability of older persons to cancer is evident. Along with the anticipated expansion of the older-aged population in the 21st century comes the implication that there will be even a greater number of older persons afflicted with cancer. MUTUAL CONCERNS