81-year old mom considering treatment

BarbEM

My 81-year old mom was diagnosed (after partial mastectomy in May 09) with Stage 1 IDC -- Grade T1c, N0, M0.  The Nottingham histologic score was 1.  It's hormone receptor positive.

Her oncologist has recommended radiation followed by an aromatase inhibitor, which I guess is a pretty standard treatment for this kind of cancer.  

My mom's generally in quite good health for her age.  And she's pretty opposed to going through with any of these treatment options; generally not very interested in medicines (she does seem to have a history of side effects, and she's already on coumadin and digoxin for a replacement heart valve.)

I've urged her to talk with her regular family doctor to get his take on the value of this treatment for someone her age.

Does anyone have any insights -- of course, I want my mom to have the best chance at never having a cancer recurrence, but at the same time, is it worth compromising her quality of life and peace of mind with treatments she doesn't really want .... 

Thanks! 

bluedasher

T1c means that the tumor was between 1 and 2 cm - fairly small. N0 and M0 mean that there were no postive nodes or mets. Stage I is the lowest stage. Nottingham scores run from 1 to 9 and are a measure of how different the cancer cells were from regular cells under a microscope. 1 is the lowest score. They get grade from the Nottingham score with scores 1 - 3 being grade 1. It means her cancer probably wasn't very aggressive.

A partial mastectomy I think means a lumpectomy where they took out the cancer and left part of the breast. Recurrence with a lumpectomy without radiation is fairly high - about 40% for 5 year recurrence but I haven't seen data on whether grade affects this. Radiation brings this to about 10%, about the same as having a full mastectomy without radiation. 

Since radiation therapy is pretty short term and usually has little in the way of side effects, it might be reasonable to do that and skip the aromatase given her age and tumor characteristics. If the cancer was on her left side, there is a small risk of heart damage from the radiation so they would probably need to be very careful to keep the radiation away from her heart. A radiation oncologist should be consulted in addtion to her medical oncologist for helping to decide whether that risk is reasonable in her case.

Leah_S

I would agree that if it left-sided the heart issue is something that needs to be clarified. Would she consider a mastectomy to avoid radiation? With her diagnosis, radiation would not be necessary after mastectomy.

I wish the best of luck to both you and your mother.

Leah