Radiation and the 'elderly'

tarry

I see various sources saying that we need to rethink radiation after lumpectomy for women 70 and above. My lumpectomy is tomorrow and I'll gladly admit to being elderly if that lets me off rads.



Anyone know about this possibility?

Shirlann

Hmm, I was 63, had no problems with rads, remember, do all you can now, if it comes back, you are finished.

Gentle hugs, Shirlann 

cimgraph

hi Tarry,

Dx March 2016, lumpectomy April 6, 2016. Started radiation therapy yesterday. My thinking was if it returns, I'll be older than I am now dealing with treatments. That and the onco did not think I needed anti hormone therapy. Radiation onco said definitely yes to radio therapy. So I'm going for it! My youngest son is getting married next summer and I'm going to dance with Andrew at his wedding!!! I'm 71! Hang tough girl! We can do it

roche

it's comforting when the RO and MO agree on the treatment. What to do if they disagree

Denise-G

My mom was 80 when diagnosed Stage 1 ER+ PR+ Her2- 1.4 cm tumor.

Lumpectomy only - rads would have only helped about 3% per the statistics.

The Tumor Board at Univ of Michigan let her make the decision, but ultimately

recommended that she did not do it.

However, you have a much larger tumor. I met numerous people in rads

in their 70s and 80s who did really well.

MinusTwo

I was 70 and did just fine. I was glad to have radiation available since I was ER/PR negative and HER2+.

ChiSandy

I was a couple of months shy of 65. My RO said that he had just finished participating in a study that found no difference in either recurrence-free or overall survival in Stage IA Luminal A patients >65 who had either 6 weeks of regular-dose whole-breast radiation or 16 treatments of hypofractionated rads to only the tumor bed. So I opted for the latter. Being Luminal A, I’m on letrozole and will continue on it for at least 4 more years.

My former office manager and I shared the same MO (and PCP). She was diagnosed with Stage IA Luminal A IDC at 72, and had only a lumpectomy & letrozole. Unfortunately, she died suddenly at 74 of an apparent heart attack (she’d suffered for years with excruciating recurrent kidney stones and had for the past 4 years had to care for her husband—my former boss & mentor—who had a massive stroke; our PCP said she was under tremendous emotional & physical stress). We’ll never know, since we Jews don’t allow autopsies unless there has been suspected foul play. But it definitely wasn’t bc that killed her. Heaven knows, radiation might have been another major stressor had she agreed to it.

keywestfan

Hi Denise-G

Can you tell me if your mother had an aromatase inhibitor like amiridex and how she has done on it? Will check in on your blog.

keywestfan

Hi tarry,

Hope your lumpectomy went very well. I have been told by surgeon, as well as from reading New England Journal of Medicine that radiation after 70 does not change overall survival and is not recommended, though might be individual choice.

Denise-G

keywestfan - my mom was able to take Arimidex for about 2.5 years without side effects. Then suddenly she began to have severe

balance issues and her MO decided it was not worth it for her as he did not want her falling. She is now 85, five years out and doing really well!

keywestfan

Thank you so much Denise-G. That calms me down

AliceBastable

My mom had a lumpectomy and 7 weeks of radiation when she was 85. She did fine, just got a little tired, but that could have been from driving to another town and back for her treatments every day. She lived to 97 and died from unrelated causes.

Salamandra

I met a lady at my rads who was just over 80. Her doctor let her skip the hormonal treatment but insisted on rads. She had fatigue, not as bad as mine but still, but was overall fine.

My understanding is that that the idea that some older women can avoid rads is only for certain stages/tumors, and it's based on the idea that there's a higher chance that something else will kill them first before they enjoy the full protection of the rads - ie a recurrence that would've happened at 8 years never happens because they already died of something else, so the rads doesn't show as benefitting her. It's not that the rads are actually doing harm. In some ways, the same effect I think works in reverse. Whatever long term risks there might have been from rads (which are so much fewer and better now than they were 20 years ago) are also less likely to apply to an older woman.

I was very resistant to rads when I first started reading about it but I have to say that the evidence is really really there for preventing local recurrence (and by extensions, some limited protection against distant recurrence). I think the question really is, would you rather deal with rads now, or have a 3-4x higher likelihood of needing to go through the whole mammogram->biopsy->lumpectomy/mastectomy->rads process later, when your body really is older and maybe more frail? Or, for me, when my health insurance might not be as good, or I might not be able to have protected sick leave, etc etc. Not just the practical concerns, but the whole emotional roller coaster this has been.

The other thing that really swayed me was the thread here about recurrences at the needle biopsy site. I have this (unsubstantiated) feeling that that is what the radiation is most helpful for. Cleaning up for any cancer that may have spread as a result of our treatment so far. That felt very concrete and real to me in a way that the abstract justification for radiation did not.

So I went for rads in the end. Some things that might have pushed me in the other direction would have been if I had some other health condition I was worried about getting aggravated, if I didn't have family leave from work to use, or if my RO hadn't been so certain that my heart and lungs would be protected from the radiation.

Still, if you decide not to, it's your call and they can't force you! Based on the new staging, it looks like you are IA. That seems like the right bucket to be in for getting medical approval for skipping rads, but it's really up to you either way.

CherokeeLady

Hi tarry, keywestfan, and all,

I need to tap into your wisdom. I'm nearly 65 and, after my lumpectomy with clean margins and no lymph node involvement, learned due to EIC finding (DCIS likely present in other ducts) at least 15 rounds of radiation are recommended. Having read these posts and looked at a few journal articles about women 60+ who are diagnosed with DCIS post-lumpectomy, it seems radiation may add 2.1 months to average lifespan. Radiation also may help prevent recurrence. On the other hand, post-lumpectomy radiation has been linked with losing both breasts later in life, heart disease/heart failure/heart attack, lung cancer.

Did anyone else have radiation therapy recommended post-lumpectomy when margins were clean and no lymph node involvement? What did you do? How has it worked out for you?

Trying to decide,

CherokeeLady

keywestfan

Cherokee Lady,

I was told pre lumpectomy by MO, BS, and even RO that no radiation was required due primarily to my age.(85). Margins were clear but close. Lymph nodes were not even tested. RO did recommend a re-excision to widen the margins. Again the margins were clean but 3mm of residual IDC was found. MO said it might be a safer option to have radiation, but if I didn’t want to and there was recurrence in same breast, I could have another lumpectomy and radiation then. RO said I could skip radiation and go directly to AI. But when I asked he said he would tell his older sister to have 16 hypofractionated treatments, partial or whole breast. I had partial. If you read my posts, you will see how freaked and terrified I was, not just the usual fear of the unknown, but humongous neurotic anxiety.

I hated radiation, but it did turn out fine- no burn, though I am very fair- skinned, no terrible fatigue. I am glad that I did it.Thought it would be a fallback if I couldn’t tolerate the AI which so far is going well.

All of it is unpleasant to say the least, but none of it was as bad as my fear.

Hugs,

Jud

movingsoccermom

My Mom was diagnosed at 81 and they specifically told her no radiation and no AI either. She is 83 now and doing well.

jessie123

I am 70 and had 3 weeks of whole breast hypofractionated radiation with 4 boosts. Got tired, but other than that no problems. I am glad because they kept dropping my tumor during the biopsy --- it kept snapping back. I then went to a different hospital and they did the same thing, but not as bad. I was terrified of the little pieces of tumor that were probably left behind. Radiation really is not bad for most people.

Mominator

My mother had radiation at age 62 (her first diagnosis) and at age 79 (her second, new primary diagnosis on the other breast).

She did well both times.

AliceBastable

Jessie123, what does "dropping the tumor" mean, especially during a biopsy? Aren't biopsies just for a sample of the tumor?

CherokeeLady

Thank you for the explanation. I opted for no rads at this time. Radiologist could not say how medical team would know whether the rads worked until and unless I develop new symptoms. Oncologist prescribed anastrozole. I had hot flashes, night sweats, bone/joint pain when I started this journey (and osteopenia), so wondering about SEs and possible natural alternatives to anastrozole.

SeattleSunshine

---

Hi CherokeeLady,

I had early stage BC, ER+ PR+ and Her2-. Luminal B. Oncotype 27. I had a lumpectomy with SLNB, node negative. I opted to forgo chemo because I did not think the small benefit in survival outweighed the known side effects. I decided to have radiation (16 rounds whole breast plus 4 boost). Overall, the radiation side effects have been manageable but harder than I anticipated. My arm pit is still healing (3 weeks since last treatment), I have fatigue (I worked a half day today) and my brain is still foggy. I think it was the right decision, mostly bc of being luminal B and deciding against chemo.

BUT, if I get early stage in my other breast, I doubt if I would do it again. I am 67, almost 70! My oncologist explained and I have read in several places, that although radiation reduces the likelihood of recurrence in the treated breast, it does not improve survival.

I support any decision you make. It takes courage to deal with cancer no matter what treatment decisions you make and ultimately you make the choice

jessie123

Alice - well two months later I finally answer. I need to make a topic a favorite after I post because I can't remember where I've been. I had ILC which is normally kind of flat, but mine was a lump. I think it was like my tumor was rubber. The radiologist would grab it and get halfway out of my breast and then drop it. That happened about 8 times. He didn't get a big enough sample for the pathologist to do the E/P or her2 testing. The pathologist said he had "innumerable small pieces" that were too small to test. I left that hospital and went to a different radiologist. They also had trouble, but not nearly as bad. I am terrified that they seeded or dropped parts of my tumor into my breast. I need to post this on some forum to see if it has happened to other people. Do you have any idea where I should post it?

metooat71

to anyone who lives close to a city where there is a Proton radiation center, call them or go there.

it takes only 2 weeks to do the same as 11 weeks of other kind of radiation.

I am 71, I just had Proton radiation in December 2019, after a lumpectomy for BC stage1, grade 3, no side effects of any kind, and peace of mind for a while.,