Older Women Treated With Hormone Therapy May Not Need Radiation
We're interested in any thought's you have on this new research studies findings:
"A study suggests that women older than 60 who have surgery to remove a relatively lower-risk type of invasive breast cancer -- luminal A breast cancer -- and who get hormonal therapy after surgery may be able to skip radiation therapy after surgery".
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Only one study? May be able to skip radiation? I have recently had bc surgery to remove 2 tumours and am 65 with no previous history. While the idea of skipping radiation is very appealing, I would need MUCH more evidence before I chose not to have it
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I love the idea of people being able to skip radiation but what would happen to people who skip radiation and start hormonal therapy but don't tolerate it and have to stop after a few months?
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kinda late for me. I am 63 and 4 months from radiation To me, one study is not enough. i would have t see a lot more studies. I have read too many post here where someone with early stage decides not to do radiation then gets a reacurrance. I was DCIS when dx., and now i am doing arimadex yet i still feel i have not done enough. Guess i am still healing emotionally as well.
I agree with Bounce and Gian.
I think there is also a limited time after surgery to get radiation. With Hormonal tx you can change to another if one does not work for you.
Would this be or all early stagers or would it depend on the receptors.
I would love to have the link to that study.
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I am age 77 with early stage IDC. Lumpectomy 7 days ago. Clean margins and neg. nodes. I am being told that I should/could skip radiation, chemo and possible even Herceptin. I will decide after I talk to the MO and discuss the Mammaprint. Would that not be amazing. To come through Breast Cancer with just a couple of scars. Maybe too good to be true.
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How wonderful that your cancer was found at such an early stage esp with neg nodes. Each treatment has it's drawbacks.
Was this found at your regular mammogram. That's why we have them. Bless you.0 -
Thanks Pheasantduster for you post. Yes, the cancer showed up as a cluster of micro calcifications on a routine mammogram. It was so small that even the Oncologist had trouble feeling it. I feel incredibly fortunate.
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MamaBexar- my sister had similar diagnosis - told, "If you have to have cancer, this is the type to have." Sort of a back-door compliment, I guess. She had radiation, then aromatase med. Myself, radiologist watching calcifications. Had previous steriotatic (spel?) biopsy a couple of years yearlier showing clear cells. I had to under go Rotator Cuff surgery in June of 2012 and with ongoing Physical Therapy, cancelled my September mammogram. Scheduled in late December and cancer was detected - Surgery 1-4-13, IDC with another suspicious, similar area that was removed along with the cancer area. First lymph node had cancer cells. Later that year I had to cope with lung infiltration from radiation, but I still feel fortunate that they found my cancer. I met so many ladies at Cancer Center that had more serious conditions but nothing took away their smiles. What an experience. Keep well.0
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I am back to report that I didn't get off as easily as I had hoped. No radiation. The thought being that mammograms every three months for a few years would be enough. Then do a mx at the first sign of recurrence. To every one's surprise, the mammaprint came back High Risk. I am now having taxol weekly with herceptine every 3 wks.
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64 going on 65 here (I go on Medicare come January). My RO told me that with my type and stage of tumor (Oncotype DX 16), were I over 70 they might not have recommended radiation. But at nearly 65, better safe than sorry. So I will be doing partial-breast accelerated radiation, which at my age is as effective as the 33-treatment whole-breast protocol. After that, hormonal therapy. (There are some outliers who advocate slender women over 70 with early non-aggressive hormone-positive cancers can even skip the hormone therapy on the theory that their adrenals make so little androstenedione and whatever fat cells they have make so little estrogen that the extra year of theoretical longevity may be outweighed by the side effects---but again, those are outliers). I feel safer having the highest-risk part of my breast irradiated, and the possibility of estrogen production by my endocrine system and fat cells foreclosed. (Wonder if liposuction, since it removes some fat cells, also lowers estrogen production).
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Hi Chisandy, I'm due for radiation after surgery, already on Femara. Would you send me a link on Accelerated Radiation being just as effective - where you got this information? I'm hoping to take it up with my RO. Th
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I'm interested in this because I'm recovering from lumpectomy and I'm really scared about radiation. Dr. has ordered oncotype, but we don't have results yet. I'm 60 and she did tell me about being over 70 and not needing it.
She told me that if no radiation, there's a 10% chance of reoccurrence and with radiation 2-3%. Waiting for report and she said to talk to radiation oncologist after we get report. But she said I'd need hormone therapy. Not sure about that either. Would love to read more about it or hear about experiences.
Linda
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After many procedures raging from mildly uncomfortable to excruciatingly painful, (that blue tracer for the SNB), I'd have to rate radiation as quite tolerable. Side effects weren't bad, and the radiation actually seems to have broken up some of the fibrous bands that were causing extreme nipple pain. My diagnosis kept on getting worse, from re-screening for "probably nothing" to "might not even be able to find the lump for a biopsy" to DCIS, to invasive DCIS-like, and finally, lymphovascular involvement. Had the usual number of grays but done over 16 sessions, which I appreciated because I live 2 hours away from the treatment centre. To add to the mix my husband has stage 4 pancreatic cancer. Oncotype DX ruled out chemo, or we'd have been sitting in matching chairs for that! I'm tolerating Tamoxifen but you always wonder if this ache or that pain is from something you've done to yourself or it's a side effect. Was cut off hormone therapy cold turkey and thought I was losing my mind for 3 months. The hot flushes are terrible, but they amuse all my friends,
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I'm 58, and because of life circumstances and the type of cancer I have, am electing to not do radiation. I had a bad hip prior to my BC Dx, and treatment was put on hold for the cancer. I had the last of a number of steroid injections to buy time 2 weeks before my BMX. The shot wore off, and my hip is bone on bone with a badly torn labrum. It needs replacement and I'm doing that 2/10.
I also chose not to do Standard chemo, as research shows it doesn't work well on my type of ILC. Endocrine therapy is best.
So it's wait and see. I'll keep the group posted as to how I do
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Hi all! First diagnosed in 2004 with 5 cm ILC followed by mastectomy and chemo and aromasin.. 2015 age 62, 5 cm again in pectoral muscle, followed by radical mastectomy and aggressive radiation. Serious radiation burns and lung involvement.
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I am 69 and have DCIS and have had lumpectomy and re-excision with still unclean margins, so will have to have mastectomy anyway...no radiation. But it is my understanding that the question of radiation depends upon the grade of the DCIS if it is high grade, it means it is fast growing and that the research results indicate that radiation is the best way to go. If it is low grade or very slow growing, then it is possible to not have radiation. I would suggest talking about this with your doctor and radiologist oncologist.
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Welcome to Breastcancer.org Gourmet. We really appreciate your input, and the sharing of your story.
Warmly, The Mods
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I am 75 years old and I developed cancer in my left breast. I didnt want a lumpectomy because if part of my body is sick and I can live without it, then its gone...My nodes are clear. So I had a mastectomy 3 months ago, and Doc said no Radiation because of my age and he didnt feel that I needed it. and on my onctest I fell in the lowest number in middle of chart. 18. So the recommendation was Hormone Therapy with or without chemo. I chose without because I am sole caretaker for my mother who is 92 years old.and really I dont have anyone to help me. But I am wondering how Tamoxifen can help me because of my age, Im sure my body makes very little estrogen and/or hormones. Lots of bad side effects
Its really a very hard decision, and I have to make up my mind before I go back to Doc.
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Hi, Odd-Ms. I’m a bit younger (65) but had a similar diagnosis--in my R breast, and I chose lumpectomy (small tumor, convenient location in a large breast) and had the 16-treatment partial-breast protocol. Except for enlarging the tumor cavity seroma and causing some fibrosis over it (which I took care of with a steroid ointment and a Swell Spot in my sleep bra at night), I got only some mild redness and tanning. No irritation or broken skin. No fatigue. And what I thought at first was nausea from radiation turned out to be hypoglycemia & dehydration because I was too busy that day to eat or drink.
At 75, you would most likely get an aromatase inhibitor (AI) such as letrozole, anastrozole or exemestane--not Tamoxifen. Even after our ovaries stop working or are removed, our bodies still make estrogen: our fat cells and adrenal glands make an androgen. Our liver makes an enzyme called aromatase that converts that androgen to estrogen. So whereas Tamoxifen clogs the tumor cell’s estrogen receptors so they can’t access estrogen, AIs actually keep us from making estrogen. The side effects beat those from dying of cancer--and the older we are when we start the AIs, the likelier we are to already have some of them anyway--basically, they’re the side effects of estrogen withdrawal. It’s manageable, and if one AI doesn’t agree with you (and other “brands” of that generic from various mfrs. don’t either) ask your oncologist if you can try another one. I seem to be doing okay on letrozole (Femara), whereas some women do better on anastrozole (Arimidex) or exemestane (Aromasin).
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Hi, Odd-Ms. Age-wise, I'm in between you and ChiSandy. I looked at my oncotype score and noted that tamoxifen would cut my chance of recurrence (that's distant recurrence, the kind we don't want) in half. "Noted" is an understatment, by the way. That fact was, and, three and a half years later, still is, chiseled into my brain. You could look at it this way--None of us has the estrogen level our bodies once had, but exactly how much estrogen does a tiny leftover cancer cell need to keep it vital?
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- At 71 I recently completed 16 days of full breast radiation which, for me, was a piece of cake. Wonderful RO , NP and techs. Getting there was a 15 min early morning walk along a beautiful creek with sociable duck families. I counted it as exercise. By the last day I was able to run almost all the way. (But slept several hours in the middle of the day afterwards) Then I went on to Anastrozole. I only lasted 4 days. It was pure hell. I think it was punishment for being so smug about enjoying the radiation experience. I'd rather go back for full body radiation if it meant I could skip hormonal therapy. I'm scared to death of trying another AI even for a day. Oncotype dx 14 so no chemo. It's amazing to me how different our experiences are...I'm not so sure how to evaluate statements that start with, "Studies show..."
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My mom was 80 at diagnosis (she is now 83). Stage 1, 1.4 cm tumor, ER+ PR+ Her2- Local hospital recommended chemo and rads.
I had her up to Univ of Michigan, an NCI Designated cancer center within 2 days - I'm a patient there, my sister is a BC patient there, and mom is a patient there.) Anyway, she had a Lumpectomy - she flew through that (was at the casino the next day much to my chagrin!) No Chemo per Tumor Board - they let her make the call on Radiation - only a 3% help in her case. She said no. She was on Arimidex for 2 years, but then started to have balance issues. She quit.
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Please Moderators- -If you are going to ask members about their opinions conerning study results or conclusions - how about actually posting a link to the published results or at the very least to an abstract of the study? How can anyone accurately evaluate a study conclusion without more information? Do the moderators feel that women over the age of 60 are incapable of evaluating data or are incapable of reading and understanding an actual study published in a peer reviewed journal?
Where was the study results published?How many women were on the study? Who conducted the study and what is their affiliation? When exactly was it done? Most importantly give us an opportunity to look at the actual data!
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I'm 70, have IDC also, ER/PR+, HER2-, Stage IIa , with one sentinel node positive out of 14 nodes removed. I had a mastectomy late August with an expander. My MammaPrint came back LowRisk. 99% chance of no recurrence with chemo and hormone blockers or 93% no recurrence with hormone treatment only. I have decided not to have the chemo. I'm up in the air regarding radiation as I'm not sure what's left to radiate. I'd like to learn your doctor's opinion if you are also Low Risk. Best Wishes on a favorable outcome.
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Swivel -- welcome to Breastcancer.org! We're sure you'll receive lots of great responses here soon!
Besa -- so sorry -- we thought we'd included the link in the original post. Sorry for our oversight. The article can be read here:
https://www.breastcancer.org/research-news/some-tr...
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My dear chat room sisters: There is not one study but several that indicate that, depending on the type of cancer, stage, receptors, etc, persons with MX may or may not benefit from radio, chemo, and cancer-controlling experiences. As you have noted, not everyone responds well to AI. I am on Arimidex and is causing me a lot of hand cramps and joint pains and decided to stay in it. I have read many, many articles on chemo and radio and rejected chemo; I was evaluated for radio and the lady sent me for a conventional protocol of 35 sessions which I will negotiate because the amount of rad, the equipment they use, and the logistics of the whole thing is too much. I had radical MX of right breast, sentinel biopsy of lymph nodes (in which the OS removed the only contaminated lymph node under the axilla), and in the PET/CT scan they found two more nodes on the supra-clavicullar fossa. That is the only region in which there is cancer activity. I will be more benefited by a partial breast rad tx or hypofragmentation, especially when they know that excessive rad can cause cancer to any of us. I sincerely have even told everyone, at the first burn, I drop out of tx. I still have a friction burn from two and half months ago and it has not cleared nor the skin has regenerated. I don't want that for my body. Not everyone reacts equally to rad or chemo, so we must be very cautious. I have had acquaintances that have died of chemo effects.
If the physicians have explained quite well the interpretations of Mammaprint and Oncotype results, chemo only adds up to the percentage of survival of women using tamoxifen. The percentage added depends really on the score one gets, according to the study's graphs. In my case I was 26 (Onco) and -.526 in Mammaprint (intermediate and high risk, respectively). However, the percentage of added "survival rate" it was 8 % on the first and 12% on the second. If you really ask me how I feel about being intoxicated or burned inside out for a 8% (12%) in chemo and 4% in radio, I will tell you the risks outweigh the benefits of chemo or radiation. They have to give me more valuable info to make a wise decision. I don't want the RO chasing cancer ghosts in my body just for the sake of a protocol because she thinks I have millions of cancer cells when I might have a few thousands. I need to be sure she won't create millions of them in trying to kill the thousands I have within me. I do believe in personalized medicine and it means that the whole tx is personalized.
The reality is that Mammoprint or Oncotype do not consider rad tx in their graphs. When I checked on the videos of physicians directing oncology sites in medical centers, they expose that in women with radical mx and less than four nodes, the added survival rate is only 4 per cent.compared to those who had mx and no rad tx at all, another time for me to think about risks and benefits. The RO who evaluated me sincerely told me that after rad tx, physicians keep checking on patients because the aftermath of rad tx.: cancer, pneumonitis, damage to heart and lungs, usually of the permanent type, exacerbation of osteoporosis, bone cancer, and many, many other undesirable long term side effects of rad. Chemo is also full of those too. So if your Dr. tells you that under your circumstances, you do not need the RT or chemo, don't push. Even going thru the chemo or rad, does not assure us of not having recurrence. And, if you go thru, there is an added percent that you may develop another type of cancer depending on the chemo agents MOs use.
So please, dear ladies, be careful. Ask, ask, and continue asking. It is hard to think that we may have some kind of responsibility on the kind of tx we receive, but is true. Drs. are not the the sole responsible for tx, we are whether we ask, inform ourselves or do the right things to achieve the best results. Hiding ourselves is not the best policy. Giving an informed consent is. And my best diatribe goes to: the ostrich. They don't hide the head in a hole to hide from danger. When they put their head in the hole, they measure distance from danger, type of danger, and a lot of info they obtain before running in the right direction.
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Hi Everyone... I just turned 67 and was diagnosed with BC... My onco score is 24 and i'm pretty much right down the middle for everything.. My MO said because of my age, the risk of chemo outweighed the benefits.. so I will be starting rads Nov. 2.. I have IDC and PNI, so am taking the 3-4 weeks.. I just want to make sure they get everything and get it done! and I've already started Arimidex.. love the hot flashes.... it could be worse, but they should make personal freezers for us if we have to have this as a SE...
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hi Sandy,
You are define,y my go to expert. I asked you before about insurance and now I can't find your answer.
I need to know if I should purchase prescription drug coverage.
I have Medicare part a&b and blue shields supplemental.
It is open enrollment now and I am wondering to select Medicare d or purchase prescription coverage with blue shield.
I haven't started radiation yet but I am anticipating the anti hormonal pills cost.I have no idea of the cost.
Thanks again,
Hope you are well.Linda
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Radiation therapy is really not that bad. I had it first on my hip and now I am walking. I am having it on my breast now and it's 15 min and I am done. It helped on my hip . They remember me there from June and they can't believe how well it worked. I did have a problem on the breast to update this.I got very red and I have scrips I have to put on.its improving but I am not quite there yet.
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Hello
I had lumpectomy last month. I am now more confused and frustrated trying to decide what follow up treatment I should choose. . My final pathological diagnosis was IDC with tubular features, , grade 1, 4mm, stage 1, grade 1, pos estrogen-prog-her- neg. margins were close, so surgeon went in again to widen margins, biopsy sentinel lymph gland- was neg also. I was told chemo was out of question, very low rate of reoccurrence, and never given that oncotype test. I was told by surgeon standard of care was for radiation, and to visit MO also. Most of the diagnoses I am finding on these posts are larger tumors, higher grades and stages and involve chemotherapy and many mastectomies. The MO made me aware of " standard care". He also mentioned the foregoing of rad and taking hormones for about 5--10 years since I am 70, in excellent health and small chance of reoccurance. However, RO recommends radiation. I don't want to over treat or undertreat. If a reoccurrence occurs, I will be faced with a mastectomy of one breast. If I choose hormones and cannot deal with side effects, I will be left without any protection. Each dr seems to encourage treatment they give. This is not helping me make a decision.
Has anyone just had a lumpectomy without radiation and /or without hormones?
I can't help feeling that this inability to make a decision is telling me that neither is right, although I do have a tendency not to be able to make decisions. My time is running out to schedule radiation. I have been reading the posts on all the terrible side effects and regrets from women who had radiation and same for hormone therapy. I don't know how to choose the best treatment for me in my situation. . Is there anyone who has a similar diagnosis who maybe have been in my situation and have had more honest and/ or straight forward medical advice than I have received?thank you
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roche, my experience is that the standard protocol for lumpectomy is radiation post surgery (as long as you have clear margins). That being said, your MO may be suggesting you avoid rads because you are node negative, low grade, and low risk for recurrence. If you choose to have rads, and it comes back, you will not have the option of rads on the same breast again. .God bless, good luck
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