Reading Task 1-Breast Cancer and the Elderly

Reading Part B : Multiple Choice Questions Instructions • Read the following text and answer the Multiple Choice Questions which follow. • Each question has four suggested answers or ways of finishing. • You must choose the ONE which you think fits best. For each question, indicate on your answer sheet the letter A, B, C or D., • Answer ALL questions. Marks are NOT deducted for incorrect answers. • Time Limit: 20-25 minutes

Task 1: Breast Cancer and the Elderly Source: Public Library of Science

Paragraph 1 Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70 years or older at diagnosis. Despite these statistics, few breast cancer trials take these older women into account. Considering that nowadays a 70-year-old woman can expect to live for at least another 12–16 years, this is a serious gap in clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and doctors need to know whether cancer treatment will affect or increase the risk for these diseases. Paragraph 2 In 1992, guidelines were issued to the Uppsala/Orebro region in Sweden (with a population of 1.9 million) that all women with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to assess data from the register to see whether women of all ages were receiving equal cancer treatment. Paragraph 3 They compared the 5-year relative survival for 9,059 women with breast cancer aged 50–84 years. They divided them into two age groups: 50–69 years, and 70–84 years. They also categorized the women according to the stage of breast cancer. They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment—i.e., surgical, oncological (radiotherapy, chemotherapy, or hormonal)—and the type of clinic the patients were treated in. Paragraph 4 They found that women aged 70–84 years had up to a 13% lower chance of surviving breast cancer than those aged 50–69 years. Records for older women tended to have less information on their disease, and these women were more likely to have unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by This resource was developed by OET Online and is subject to copyright © Website: http://oetonline.com.au Email: [email protected]

mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients. Paragraph 5 Current guidelines are vague about the use of chemotherapy in older women, since studies have included only a few older women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if the tumours did not show signs of hormone sensitivity. The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an alternative. Paragraph 6 The researchers admit that one drawback of their study is that there was little information on the other diseases that older women had, which might explain why they were offered treatment less often than younger patients. However, the fact remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger women— despite accounting for one-third of all breast cancer cases in the country— and those older than 74 years are not screened at all. Eaker and co-workers' findings indicate that older women are urgently in need of better treatment for breast cancer and guidelines that are more appropriate to their age group. Developed countries, faced with an increasingly aging population, cannot afford to neglect the elderly. Questions-Part B 1. The main idea presented in paragraph one is that…… a. only older women need to be concerned about breast cancer. b. breast cancer trials seldom consider older women. c. breast cancer is more common than other diseases in older woman. d. older woman do not take part in breast cancer trials. 2. Regarding cancer treatment in paragraph one, it can be concluded that…. a. doctors know cancer treatment will increase the risk of disease in elderly patients. b. cancer treatments too risky for elderly people c. it is unknown whether or not cancer treatments will affect the treatment of other diseases in elderly people. d. older woman are less likely to have other diseases

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3. According to paragraph two, the 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that… a. Sweden has a population of 1.9 million. b. women with breast cancer need to register their condition to ensure they receive equal treatment. c. identical breast cancer treatment should be available to women of all ages. d. all women with breast cancer should have access to equivalent breast cancer treatment. 4. According to paragraph 3, which of the following was not part of Sonja Eaker and her colleagues research? a. Comparing ability of breast cancer cells to increase in number. b. Grouping woman according to their survival rate. c. Identifying differences in treatment methods. d. Splitting the groups based on age. 5. According to paragraph 4, which of the following statements is true? a. Older women have fewer lymph nodes b. Mammography screening is not able to detect cancer in older women c. Only 13% of women aged 70~84 survive breast cancer d. Women aged 50~69 have a lower mortality rate than women aged 70~84 6. In paragraphs 5, findings by the researchers indicate that……. a. older women are not usually advised to have chemotherapy b. older women prefer hormone treatment such as tamoxifen c. breast conserving surgery was not popular among older women d. older women respond better to chemotherapy than to hormone treatment. 7. The word vague is paragraph 5 means…… a. uncertain b. unclear c. unknown d. doubtful 8. According to paragraph 6, one limitation of the study is that….. a. older women are treated less often than younger women. b. older women have a lower incidence of breast cancer. c. younger women are treated more often than older women. d. there is a lack of information on other diseases which older women have. 9. Which of the following statements best represents the view expressed by the writer in paragraph 6? a. Due to ageing population in developed countries, the needs of the elderly must not be ignored. b. Older women need more appropriate treatment to suit their age. c. Most developed countries have neglected the elderly for too long. d. It is too expensive treat the elderly.

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Answer Key 1. b 2. c 3. d 4. b 5. d 6. a 7. b 8. d 9. a Question 1 a) Incorrect: incorrect assumption b) Correct: see highlighted text c) Incorrect: it is present with other diseases, not more common d) Incorrect: usually they do not take part but not always Question 2 a) Incorrect: Doctors don’t know this. b) Incorrect: not mentioned c) Correct: see highlighted text d) Incorrect: not mentioned Question 3 a) Incorrect: The statement itself is true, but it has nothing to do with the guidelines b) Incorrect: Not given, note that register is used as a verb here to confuse the test taker c) Incorrect: identical is not a synonym for equal d) Correct: equivalent is a synonym for equal. Question 4 a) Incorrect: Mentioned..proliferate is synonym for increase b) Correct: They were not grouped based on survival rate, rather the stage of cancer c) Incorrect: mentioned d) Incorrect: mentioned Question 5 a) Incorrect: Fewer lymph nodes examined b) Incorrect: less likely to detect is not the same as not able to detect c) Incorrect: not given, statistic is different d) Correct: Same meaning, see highlight Question 6 a) Correct: See highlighted test b) Incorrect: older women’s preference is not mentioned c) Incorrect: not mentioned d) Incorrect: possibly true but not mentioned or indicated by the researchers Question 7 a) Incorrect b) Correct: Check your dictionary and thesaurus if you got this wrong! c) Incorrect d) Incorrect Question 8 a) Incorrect: This information is true but is not related to their study b) Incorrect: Not mentioned c) Incorrect: This information is also true but is not related to their study d) Correct: see highlighted text Question 9 a) Correct: See highlighted text b) Incorrect: This the research findings not the writer’s opinion c) Incorrect: Could be true but not mentioned d) Incorrect: Trick question connecting the word afford & expensive

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Answers –Highlighted Paragraph 1 Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70 years or older at diagnosis. Despite these statistics, (1) few breast cancer trials take these older women into account. Considering that nowadays a 70-year-old woman can expect to live for at least another 12–16 years, this is a serious gap in clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and (2) doctors need to know whether cancer treatment will affect or increase the risk for these diseases. Paragraph 2 In 1992, guidelines were issued to the Uppsala/Örebro region in Sweden (with a population of 1.9 million) that(3) women with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to assess data from the register to see whether women of all ages were receiving equal cancer treatment. Paragraph 3 They compared the relative survival for 9,059 women with breast cancer aged 50–84 years. 4d They divided them into two age groups: 50–69 years, and 70–84 years. They also categorized the women according to the stage of breast cancer. 4 a They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of lymph nodes examined, and lymph node involvement. 4c The researchers also compared types of treatment—i.e., surgical, oncological (radiotherapy, chemotherapy, or hormonal)—and the type of clinic the patients were treated in. 4 a, c, d mentioned above. Therefore answer is b Paragraph 4 (5) They found that women aged 70–84 years had up to a 13% lower chance of surviving breast cancer than those aged 50–69 years. Records for older women tended to have less information on their disease, and these women were more likely to have unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by mammography screening and to have the stage of disease identified, and they had larger tumors. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients.

Paragraph 5 Current guidelines are (7)vague about the use of chemotherapy in older This resource was developed by OET Online and is subject to copyright © Website: http://oetonline.com.au Email: [email protected]

women, since studies have included only a few older women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if the tumors did not show sign of hormone sensitivity. (6)The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an alternative. Paragraph 6 The researchers admit that (8) one drawback of their study is that there was little information on the other diseases that older women had, which might explain why they were offered treatment less often than younger patients. However, the fact remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger women— despite accounting for one-third of all breast cancer cases in the country— and those older than 74 years are not screened at all. Eaker and co-workers' findings indicate that older women are urgently in need of better treatment for breast cancer and guidelines that are more appropriate to their age group. (9) Developed countries, faced with an increasingly aging population, cannot afford to neglect the elderly.

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