Radiation benefits & Risks for early stage cancer
Hello, I am preparing for lumpectomy and then radiation/AI expected. Despite bilateral the surgeons feel I am a good candidate.
Any suggestions on where I can get risk/benefit analysis for radiation treatment?
I am 58 bilateral IDC/DCIS Grade 1 T1b no nodes
ER/PR+ Her2neg No BRCA genes and low Ki-67
I have spoken with doctors and yet I can't get a clear sense of value/risk. I have used the predict calculator and radiation seems of low benefit?
Where do you find the likelihood of return for similar stage/type cancer?
I see comments about "30% reduction" but reduction from what chance of recurrence? It is a big difference if recurrence rate is 8% vs 80%.
And I understand Rads can only be done once to breasts. So if chance of recurrence is low… why not reserve that for a recurrence then hit hard so to speak? My oncologist feels metastasis is unlikely for me and if a return most likely to be local.
It seems like a practical consideration to me and obviously with some risk but that is what this is all about risk vs benefit.
I am older so quality of life throughout for my next decade is a big consideration for me.
Thank you for any feedback.
Ella
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Hi @ella26, The best place to get a risk/benefit analysis for your particular situation is from a radiation oncologist. ROs are sometimes not as accessible as breast surgeons or medical oncologists but there will be an RO in charge if you have radiation. If you have spoken to a RO you could message them via your patient portal asking for a statistical calculation. If you have not, ask for an appointment with one even if you end up getting treatment supervised by a different RO or not having radiation.
The general benefit is a 35 - 50% reduction in local recurrence. The benefit for IDC is lower than the benefit for DCIS which is why you want a personalized answer. The reduction is subtracted from the recurrence rate with no treatment other than surgery. If your recurrence rate is 30% then radiation would reduce it by 10.5 to 15% leaving you with a recurrence risk of 15 to 19.5%. Since rads mainly prevents local recurrence the survival statistics indicate that radiation has little effect on whether you die of breast cancer. Since the dose of radiation allowed is limited a mastectomy is the treatment for recurrence in a radiated breast.
The other piece of the puzzle is endocrine therapy which has its own risk reduction stats, The two types (AI and tamoxifen) work in different ways and have a variety of possible side effects. If you are not going to commit to 5 years of these meds then radiation is more important for prevention. For women over 50 there are hypofractionated radiation protocols where larger doses are given over a shorter time period and the total dosage is less but just as effective. Two of these are FAST (5 doses one every week for 5 weeks) and FAST forward (5 doses once daily for a week.) These options might not be available everywhere but large teaching hospitals usually have them.
There are risks associated with rads which you can read about in the topics section on this site. Many people have some redness, skin peeling, swelling and fatigue which clear up. Lymphedema risk is about 5% for WBRT. Other serious SEs do occur in less than 1% of patients. The only contraindication publicized is scleroderma but there seems to be a higher risk of complications for anyone with an autoimmune disease. Make sure to tell the RO about any medical problems you have.
Disclaimer: I had whole breast and axillary radiation (one positive node) because I had decided not to take AIs/tamoxifen due to their detrimental effect on other health issues I have. Unfortunately I ended out with several serious side effects to my lungs and neck region. The pulmonologist I was referred to told me that a lung cancer RO would have taken note of my medical history (upper GI bleed, Barrett's esophagus) and recommended against rads. MD Anderson is investigating how a mutation in the TGFbeta1 gene (which I most likely have) seems to trigger many of the serious reactions. They are hoping to develop a test to identify patients with it but research is in the early stages.
I still think I made the best decision I could with what I knew at the time and believe that radiation is safe and effective for most people. Unfortunately statistics can't predict what will happen to you and hindsight is 20/20. Cancer recurrence can also be serious, however. All the best with your decision.
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Maggie, thank you for taking the time to share I appreciate it and it is helpful to me.
Yes, I am insisting on a meeting with the Rad oncologist. In the meantime I am trying to educate myself and hear from people who have been through it like yourself. For better or worse. All of this is unknown to me and I want to make the best decisions I can.
I'm sorry to hear you had complications but as you say, we make the best decisions we can at the time. Treatment has costs and I accept that within reason.
Best, Ella
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My advice is to have radiation. The goal is to get rid of any cancer cells that may be lingering (and are too small to detect) NOW. There is no use to 'save it for later' because if there are any cells left, they will escape and show up in some up of the body. Then you will be Stage IV. 58 is young!! You want to do everything you can to ensure many more healthy, cancer-free decades of life! For what it's worth, I found radiation to be the easiest part of my treatments (lumpectomy, chemo, radiation & 5 years of an AI).
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