Anyone 75 and over being treated for breast cancer?
This is my 3rd go 'round with breast cancer. The first 2 times it was the whole 9 yards - chemo, surgery & radiation. My last oncologist told me bluntly that my body couldn't take anymore chemo. I couldn't agree more. Chemo has been devastating to my body. It seems that this new cancer is small and early stage, so surgery is the next logical step. I'm unable to take hormone suppressing drugs because of side effects, even though this hasn't been definitively diagnosed as ER+, I'm pretty sure it is. That only leaves radiation, and I've already had a ton of that. Ya don't appreciate skin until you don't have it! According to research papers I've been reading, radiation may or may not be particularly helpful in geriatric bc patients. I was wondering what sort of treatment any women in their 70s and older have had for breast cancer. It seems to me that it comes down to a quality of life issue for me. I have never been afraid of cancer (it just makes me very angry!). I'm not afraid of dying but I sure don't want to suffer any more than I already have. If you've been through it, you know cancer treatments can be long and grueling. The first time for me there was no Zofran and I was allergic to Compazine, so I had to cold turkey chemo without any anti-emetic - and I was being given Big Red or as some call, the Red Devil. I hope there's someone out there who can give me some advice or the benefit of their experience.
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I was diagnosed in 2019 with stage 2, ER+, PR+, HER2-, clear nodes , had lumpectomy, standard radiation and anastrazole. 2.5 years later, bone mets were discovered and I was Stage IV. Radiation for the two most dangerous mets (one in the clivus bone in the skull), prescribed Kisqali, fulvestrant, and Xgeva, which is still my current treatment. Once I navigated an initial adjustment period of a few months, Kisqali is very tolerable. I also have significant arthritis and nerve damage resulting from the initial surgery, so I take gabapentin and celebrex daily. At 75, I feel a little battered, and certainly have less energy than my younger, healthier self, but I am able to perform all the tasks of daily living, exercise each day, play with my grandchildren and travel where and when I choose. Since my Stage IV diagnosis I have visited 13 different countries - some of them more than once - and I'm planning future trips. While my current condition is not as strong as I'd hoped to be, I think I live a normal, active life for my age.
I've never had chemo and not sure what I'd decide if it were recommended, as QOL is also my priority. There are others on here close to 75 and some older, so hopefully they will share their experiences.
Please keep us posted on your treatment decisions.
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eleanora, I'm glad you're doing so well. I'm particularly glad you have not had to have chemotherapy. It was brutal, both times. It has been the gift that keeps on giving. Osteonecrosis causing me to have hip replacement surgery, early and rapidly developing cataracts requiring cataract surgery, macular degeneration, and many other problems. The first time, I was given a drug they call the "red devil", adriamycin. The second time was almost as harsh. It's the long-term effects of chemotherapy that are either not mentioned or down-played. Tamoxifen made me suicidally depressed. At the time, I was already on high doses of 2 antidepressants even before starting tamoxifen, so they took me off of it. I don't see hormone therapy as being an option for me. Since all of the chemo, I find that my body is particularly sensitive to pretty much any medication, even antibiotics. Before I had all of the chemo, I didn't have problems with medications. So I'm not optimistic about being able to tolerate any "targeted" therapy, either. You may think my attitude is pessimistic, but I feel it's just realistic, based on past experience. I haven't seen an oncologist yet - I hope it will be soon, so I can get the surgery over with. I'm glad I did all of my traveling when I was young, because in spite of being a fairly active 75 year old, the idea of travel is daunting. Nevertheless, I've worked very hard over the past years to maintain a healthy body and active lifestyle, so compared to a lot of women our age, I guess I would be considered pretty darn healthy - except for having cancer again! I can't believe I'm facing this all over again. The times I had cancer, I never thought I was going to die - not that I'm afraid of dying. I wasn't afraid of anything except the miserable treatments. Since chemotherapy and hormanal therapy are off the table for me, I don't know where this is going to take me, but you can imagine how miffed I am that I'm facing this once again. It was nice of you to respond and I am really happy that you are doing so well.
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Hi @bluesinthenight, Three bouts of breast cancer is tough to deal with. I was diagnosed at 69 and had surgery and radiation, whole breast and axillary because I had a positive sentinel node. I didn’t take AIs for a long list of reasons, estrogen deterring esophageal cancer which I’m at risk for at the top.
The latest research shows that women over 70 can skip rads if they take AIs. There are some new radiation protocols available for women over 50 that are easier than the older ones, FAST (5 treatments once a week over 5 weeks) and FAST-forward (5 treatments in a week) as well as partial breast radiation where just the tumor bed is radiated. A RO would have to figure out your previous dosage and the number of intervening years to see what would be recommended for you.
You should ask how much doing any treatment would reduce the risk of recurrence to help decide if it’s worth it for you. I agree that when you are in your seventies QOL is the priority. I hope you end up with a treatment plan that has minimal side effects. All the best.
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Hi, @bluesinthenight,
I'm not quite 75, but I'm pretty close (73). I'm recovering from surgery for my second bout of breast cancer.
My first diagnosis was 18 years ago, at age 55. I had a 1.8 cm (Stage 1) IDC that was ER+ PR- HER2-. Sentinel nodes were negative. I had a lot of fibrocystic tissue in my breasts, making it difficult to sort through all the lumps; and although it was palpable, the 1.8 cm mass was never detected on a mammogram. For those reasons and others, I decided to have a mastectomy instead of breast-conserving surgery (lumpectomy + rads) and to forego reconstruction. My surgeon complied, leaving me with an "aesthetic flat closure" on the left side. My Oncotype DX score was 26, so I did end up getting 4 rounds of Taxotere & Cytoxan, followed by 10 years of Arimidex.
Fast-forward to November 2025: I had my first-ever call-back because of a suspicious area on a screening mammogram. There were "grouped, pleomorphic microcalcifications, but nothing was palpable this time. The result of the biopsy was high-grade DCIS: nuclear grade 3, solid type, comedo necrosis etc. My primary care doc warned that it would probably be up-staged to IDC after surgery. The cells were ER+ PR+ this time.
Even though I was again a candidate for breast-conserving surgery, I didn't want rads and wasn't interested in dealing with BC a 3rd time; so I chose another mastectomy with a flat closure. The surgical path result remained high-grade DCIS, and sentinel nodes were negative. I was referred to a med oncologist because of the prediction of up-staging. He pointed out that the only treatment he would have recommended was an estrogen-blocking drug (most likely an AI), but even that was unnecessary in my case. "There's nothing there for a recurrence to recur in."
Each of us has to choose our own path through this maze. My choice(s) might be seen as extreme, but I didn't want to be struggling with some of the issues you're facing, like whether to endure radiation again. I do hope your new dx is as "small and early stage" as you've indicated. Yes, there's been a move toward lightening up on treatment regimens for women our age — skipping radiation after a lumpectomy, for example. There are risks with that, however. One thing to keep in mind is that the changes are seen as a trade-off between dying of breast cancer vs. dying of something else. When we reach a certain age, the actuarial tables shift toward other causes of death taking us before the cancer does. Your mileage may vary — i.e., remarkably healthy for your age, vs. frail with co-morbidities.
Best wishes, no matter what!
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Hi @Maggie15 & @otter,
I've already had so much radiation that I think it's unlikely that they might want to do more. I also have grave misgivings about any hormone suppressing drugs. I already have been diagnosed with osteopenia, I have moderately high blood pressure (controlled) and a host of other problems - many of which I believe are the result of the massive amounts of chemotherapy I've had in the past. I was first diagnosed at 50 with HER+ ER- and they bombarded me with the worst chemotherapy they had - Adriamycin, as well as a lot of radiation (to the point where I had extremely painful radiation burns). I was also allergic to the only antiemetic available at the time (no Zofran then) so I had to endure chemotherapy without anything.
The second time, 12 years later, was ER+ and I was clobbered with more chemotherapy which subsequently caused osteonecrosis that required hip replacement surgery. It also brought on early and rapidly developing cataracts as well as macular degeneration. I was already on high doses of 2 antidepressants before I started Tamoxifen. It caused depression so severe that I became suicidal, so I was told to discontinue it. I'm terrified of the side effects of any of the hormone suppressing drugs and wondering if it comes down to a quality of life issue at my age. Is it worth all the side effects in order to live longer?
This current cancer has been caught early and is small. Surgery is obviously necessary. I don't have a problem with a total mastectomy (or double mastectomy) without reconstruction if that would mean I wouldn't have to take hormone suppressing drugs. I've been subjected to so much suffering already (not just from breast cancer - unrelated stories)…
I have noticed that since chemotherapy I have become extremely sensitive to any kind of medications - even antibiotics have serious side effects for me. That's another reason I'm leary of taking any more drugs of any kind.
I think what they're going to want to do is surgery and AI's, but not chemotherapy and radiation because I've already had so much of those. I won't lie to my oncologist and say I'm taking AI's and then not take them, but I expect an argument over AI's. I feel that my options are limited at this point - if my surgeon thinks a radical mastectomy would spare me AI's, I'd do that, but I'm not sure what she's going to say until I see her. Nothing happens in Louisiana until after Mardi Gras, so I won't be able to see her for another 10 days.
FYI, I never lived in fear a recurrence and have been surprised both times. I was never afraid of the cancer itself when I was diagnosed. I never thought I was going to die either time (though the chemo sometimes made me wish I would!). I'm not afraid of death, and at 75, I don't want to suffer anymore than I have to in whatever time I have left. Sure, I'd like to stick around, but at what price? Is it worth it to be miserable on AI's? I already have a host of problems that I'm dealing with that trace back to chemotherapy, adding to them with AI's seems like madness.
I'm not expecting y'all to have answers for me. I feel like I'm howling into the wind. I guess I'd like to know what experiences people have had, positive and negative with AI's.
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Quality of life is always an issue. Living longer but being miserable or in constant pain is not a reasonable choice, IMHO.
As for experiences with AI's, I'll admit I'm probably an outlier. I was started on Arimidex in 2008 because I was post-menopausal, and Arimidex was considered equivalent to Femara (letrozole) but was better-known. I had some mild aches and vaginal dryness but I'd had similar symptoms earlier in menopause, so who can tell?…. Oh, and I was already mildly osteopenic before I started Arimidex, only the docs at my cancer center weren't very worried about that: "Osteoporosis is treatable. Metastatic cancer, not so much."
At the 5-year mark, my med onc and I discussed whether to continue on Arimidex for another 5 years or stop treatment. We agreed that my risk of distant recurrence (mets) was high enough to justify continuing, so we agreed to split the difference at 7-1/2 years. When I hit that time point, my med onc advised going ahead for the full 10 years, since I was tolerating it so well. (My bone density had not changed.) She said she'd have supported stopping earlier if I hadn't been "high risk." (That pesky Oncotype DX score of 26 ensured I'd get chemo, but the benefit was predicated on the assumption I'd also be getting an estrogen-blocking drug.) So, I had 10 years of an AI with only minor side effects. That's unusual, I think.
I can't speak for you, but I, too, would be hesitant to add anything that didn't offer a clear benefit with minimal impact on my quality-of-life.
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Otter,
Thank you for your response. I'm glad that you've tolerated Arimedex well. I'm sure others have tolerated these drugs well, too. Vaginal atrophy ("Atrophy" is NOT a word you want applied to any part of your body, especially your vagina! 😱) was an artifact of the Adriamycin (doxorubicin) that I was given 25 years ago. It wasn't just dryness. That would've been easier to cope with. I've been trying to remedy that for 25 years in various ways with limited success. And no one warned me about it.
No one told me about any of the side effects of any of the chemotherapy I was given. Fortunately, I have an understanding husband. My cancer treatments and the subsequent fallout from them have been devastating, but I didn't even hesitate the second time. I just thought, "Here we go again." I was bummed, but not frightened. That second round of chemotherapy drugs caused osteonecrosis of my hip requiring hip replacement. "Necrosis" is another word you don't want to hear applied to any part of your body! 😬
I found an interesting thread today in which a woman mentioned a website whereby one could determine the benefit of hormone suppressing drugs given age, size, type, stage of cancer…all the particulars. She said that after doing that exercise, she decided not to take the drugs.
Once I completed the form myself, the results in my case were that after 5 years without a hormone suppressing drug, the survival rate was 87%. Not bad. But WITH a hormone suppressing drug, the survival rate was…(wait for it)…87%. 😳 So I looked at 10 years. Mind you, these are predictions for all cause death and cancer death, so at 75, obviously all cause of death is going to be higher at 10 years. The difference at 10 years was 67% with the drugs, and 66% without. I'll quote directly:
"66 out of 100 women treated with surgery only, are alive at least 10 years from surgery
- 67 out of 100 women treated with hormone therapy are alive (an extra 1).
Of the women who would not survive, 31 would die due to causes not related to breast cancer."
Remember that these statistics are predicated on my age, the size of my tumor and other details relating to my case only.
While the website makes clear that it is recommended that patients use the tool in consultation with their physicians, they also note that "Treatments usually have the potential to cause harm as well as benefit. It is important to weigh the risks of potential harm against the potential benefits of treatment in order to reach a decision. Some may cause more harm than benefit to some people." I understand that there are some who will argue with my use of this calculator and that's understandable.
For those that are interested, the website is the "Predict Breast Cancer Tool." Development of the original model was a collaborative project between the Cambridge Breast Unit, University of Cambridge Department of Oncology. Cedars Sinai and the American Joint Committee on Cancer are also listed as participants.
This tool put me in mind of a similar tool for statin use. When I was pressed to take statins, I found several different reputable calculators, and once I determined that my risk for a cardiac event in the next 10 years was low even without statins, I decided not to take them. I have read too much about the evils of statins. But that's another story.
I have had a lot of harm done to me by well-meaning physicians prescribing medications that did me much more harm than good. As I'm now considered a geriatric patient, I know that polypharmacy is one of the evils visited upon older adults. One drug to treat the side effects of the first drug, ad nauseum. I've managed to get off of or significantly lower doses of any and all of my medications, paring it down to 4 (still trying to get off of a couple more) from 10 at one time.
So if I seem to be extraordinarily wary of taking any more medications, especially ones that seem to cause many women severe side effects, I hope you'll understand why. If I were younger, I might take a different stance. But this is a decision each individual must make with their doctor depending on what they believe is in their best interest. I'm not trying to convince anyone not to take them. This is just about my decision making process.
Ladies, I'm sorry that this is so long. But thanks to those of you kind enough to respond to my cry for help and patient enough to read all of this! ❤️❤️❤️❤️
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