Over 70 and wondering
I recently had a lumpectomy in my left breast. My pathology showed a very early stage 1A cancer with negative margins and no nodal involvement. I met with the radiologist the other day and I'm scheduled to meet with the endocrinologist in early July. I am seriously considering not doing either. I am going to be 77 in September, generally in good health. I'd love to get some input from anyone who may have made this decision.
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Hi Bertrho - a warm welcome to the forum. There are a few articles on here that address your questions. I am unable to link them, but if you use the search function for “older women radiation” they should pop up. Or perhaps the mods can link them.
I was 63 (now 67) when diagnosed with Stage 1A and I have a genetic mutation. I had a lumpectomy and my breast surgeon did not think I needed radiation, however, the radiation oncologist followed the standard of care at that time which was (in my case) accelerated partial breast radiation for 5 treatments. There is some thinking that older women may not need radiation as the benefit does not outweigh the risk. This is dependent on your individual factors.
With regard to hormone therapy that is something you need to discuss with the endocrinologist or a medical oncologist. The aromatase inhibitors can negatively impact bone density so that may affect your decision if you have osteopenia or osteoporosis. I took anastrozole for almost 2.5 years and stopped when my bone density dropped by 9% in 2 years. This was against the doctor’s advice but I didn’t want to risk a hip fracture.Best of luck with your doctor visits and decisions.
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Hello, hope you're recovering well from your surgery. Sorry you're here, although it's fantastic you find yourself in otherwise "good health", other than being on the mend from surgery. Please keep advocating for yourself and follow your gut instincts, although it never hurts to seek out a second medical opinion. Please be aware more women >70 die from non-BC causes. Best wishes as you move forward and hugs.
OPTIMAL ADJUVANT THERAPY IN OLDER (≥70 YEARS OF AGE) WOMEN WITH LOW-RISK EARLY-STAGE BREAST CANCER
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Hi Bertrho, Studies have been done showing that radiation or endocrine therapy can be skipped in women over 70 with small tumors with no adverse effects. I haven’t seen any studies where both treatments were not done.
According to SSA tables the life expectancy of a 77 year old woman in good health is about 10 years. You should ask both doctors about the risk of recurrence and any survival advantage that would be gained by each treatment over that time span. If the risk is small avoiding possible side effects might be worth it in your estimation. As you get older quality of life becomes more important. All the best making an informed decision that is right for you.
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I was almost 65 when dx'ed with a small Stage IA Luminal A tumor, clean margins, low OncotypeDX. No gene mutations. I had lumpectomy, accelerated short-course partial breast radiation (16 treatments) and endocrine therapy—in my case Letrozole. I already had osteopenia, so I went on semiannual Prolia shots for 3 years. But Letrozole spiked my cholesterol (especially LDL), so I had to go on a statin, which spiked my glucose & a1c into early prediabetes. It also slowed my metabolism to the point where I gained 35 lbs (my BMI was almost 34)—then put on near-keto which worked for awhile (lost 45 lbs) till it became boring & frustrating so I regained 35; only going on Zepbound made it possible to reach a normal BMI & a1c and maintain it for a year. With my MO's blessing I quit Letrozole after 6-1/3 years, once the Vienna study emerged that over age 70 the osteoporosis & cardiovascular risks of 7 years of endocrine therapy outweigh the benefits.
The last straw for me was when after stopping Prolia after 6 shots (the protocol for osteopenia at the time) the next DEXAscan showed my osteopenia had become osteoporosis. So now I'm on semiannual Prolia for 10 years to life. And even before the Zepbound weight loss (fairly rapid on the lowest dose), Letrozole had considerably thinned my hair. It's only now starting to grow more normally.
I'd say yes on the rads—my side effects were extremely minimal—but talk seriously to your MO about spurning endocrine therapy. At 77 a heart attack, stroke, or broken hip is likelier than a recurrence.
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