Standard care for seniors following lumpectomy

roche

Hello,

I am trying to connect with women over age of 60 who have had lumpectomies, stage 1, grade 1, with very good prognosis, and what choice of follow up treatments they chose and or received.

There is a study that suggests foregoing radiation and opting for hormone therapy in older women. I'm not sure whether this study has more to do with the pathology, or the longevity stats of the women. I am a healthy, med free senior who is being given the choice of either or, and am wondering if other women my age have chosen radiation, gone the hormone route, or done nothing.

I don't want to be over treated. The oncologist recommends meds. The RO recommends radiation.
I am fearful of both.

Do many older women belong to Breast cancer.org? I am finding it difficult, searching and navigating my area of concern and relating to women my age with similar diagnosis. I'm ready to give it a rest.
Thanks,
Roche

micronancy

I totally fit your criteria. My RO actually suggested no radiation and although my oncologist was not happy, I opted for hormonal treatment only. Unfortunately, I ended up not being able to continue hormone therapy, so I've had a lumpectomy only and am over 4 years out with no problems. I am comfortable with my decision and still have radiation available if there are any future problems.

keepthefaith

roche, I don't have the exact DX as you do, but close. Have you had other tests? BRCA? Onco-test? Family History? Other health issues? There are a lot of factors to consider. I had an intermediate onco-score of 21 and family history, so I did pretty much everything...I was 58 when DX'd. My tumor was close to my chest wall. Good luck with your difficult decisions.

roche

Hi

Thank you so much for sharing your decision. knowing you made the right decision and that you are doing well is very comforting. Getting an ok from RO to forego rads is terrific I have just the opposite response from doctors. The one RO encouraged rads likening it to an insurance policy, the other said rads could be done again on same breast,(?) since I was concerned about reoccurrence in the future, and both referenced it being the shorter treatment. The two oncologist recommend hormone therapy. And being older I'm not sure if both treatments are necessary

Goincrzy8

check the Lumpectomy lounge and there is a forum for ladies over 60, only problem with that is they are all out of treatment, but still very knowledgeable

roche

i will, thank you

roche

Hello Keepthefaith,

I do have breast cancer in my family. My sister, diagnosed with triple negative, managing. She and my daughter tested negative for braca, and I never went for test. I had asked the surgeon about the oncodx test, but was told it wasn't necessary, b/c I wasn't going to need chemo. I am 70 (hard to admit), but I have always been healthy and not on any meds. I'm going back to the first MO I consulted with, right after lumpectomy and before I ever knew about treatments, to discuss again his recommendations. I have to admit at that first meeting I told him I wasn't going to do both treatments-rads &hormones. He then said it would be ok to pick one. I've since educated myself some on the treatments and need another consult. However, I did consult with another MO who basically told me I did not need rads, just hormone pill. RO that I have consulted with all seem to want to do rads. I'm still confused as to the use of chemo. Thank you for sharing, I appreciate you taking the time.

duckyb1

My diagnossis is very similar to yours.......I had a lumpectomy, followed by 38 Rad treatments......hesitated taking Femara but finally gave in.......I had no problem with Rads.barely turned pink........a bit tired after it was over, but that was it..........however the Femara was awful.....after a couple months of being on it I got every side effect but hot flashes.......aches, pains, thinning hair, trigger thumb, etc......i did it for four years, and finally said enough is enough .......still not sure if I did the right thing going off...........it is one year, since I did, and yesterday I was 6 years since I was diagnosed........just keeping my fingers crossed.........it is an individual decison......some have no problems, or maybe a few...........others get them all......hope you do well.

Denise-G

My mom was age 80 at diagnosis for Stage 1 ER+ PR+ Her2- IDC. She had a Lumpectomy.

Radiation would have only helped her about 3%, so she decided not to do it. She was on

an AI for 2 years but developed severe balance issues.

She is now off the AI - but is now 83 and doing well.

mustlovepoodles

If I were >70 I would not choose chemo, radiation, or AI. I mean, what would be the point at that age? However, I was almost 59 when my cancer was discovered. My mother is 82, so potentially I could live another 23 years. Therefore, I chose to be aggressive with my aggressive tumor.

SpecialK

I was 54 at the time of diagnosis and had to make choices based on the details of my situation, and it is possible I might make different choices at 70, I am 60 now. I do have a good friend who was diagnosed at 69 with ER+/PR+/Her2-, stage 1, grade 1 cancer high up on the breast. She is tall and thin so they didn't even need to do a wire localization to remove the mass. She opted to have the Canadian protocol rads - spanning 15 treatments over 3 weeks, she did very well with this and continued to work full time, going for rads at the end of the work day. She did opt not to take the anti-hormonal drugs. It is important to remember that most docs in this process will sometimes push their own agenda based on specialty - surgeons operate, medical oncologists manage systemic treatment, and radiation oncologists radiate. If their respective treatments are the standard of care they most often will tell you that you need them, it is somewhat unusual for them to suggest that you don't. If have seen the reference to older women skipping rads, but it is important to look at the study population, and what is considered successful. You may have already seen it, but here is a link to that study:

https://community.breastcancer.org/forum/73/topics/785809?page=1#post_2963541

Also, for me, the bottom line would be if the cancer recurs - in the breast or elsewhere - will I be ok having forgone treatment that could possibly have kept that from happening? I tend to be a better safe than sorry person, so I would most likely do the rads, but attempt to get the shorter course, and try the anti-hormonals. You can always stop if either is too much.

Here is a link to the thread for those above 60:

https://community.breastcancer.org/forum/104/topics/728699?page=428

MinusTwo

Sorry, I had to jump in even though I had a BMX for my original stage -0- DCIS.

MustLovePoodles - I guess I'm an 'older woman'. But then again, each one of us is different and my family longevity history is usually into the mid 90s. I was 69 when I had a recurrence in a lymph node. I had previously had BMX w/reconstruction and no other treatment 2 years before at 67 when I was ER/PR negative. Because the recurrence was ER/PR negative AND HER2+, I really had no options except chemo &/or rads. I was very healthy going into all of this. I could see another 20 years ahead for me. Aside from mild neuropathy and mild truncal LE, I'm getting back into the same great shape I was before.

That said, I will not be likely to choose chemo again if I have another recurrence.

ChiSandy

I was diagnosed with Stage IA IDC, Luminal A at almost 65. With an OncotypeDX score of 16, my MO agreed with me that chemo’s risks far outweighed its benefits for a small and nonaggressive cancer. Micronancy, with an ODX score of only 13, why on earth was your MO “not happy” with your choice not to do chemo? How old-school is (s)he? Something sounds discordant here.

And my RO said at my age, stage and with my type of cancer (especially its high-and-outside location), I was a candidate for the 16-treatment Canadian protocol, and just to the tumor cavity at that. Jumped at the chance, and my experience was unusual: no fatigue, hardly any redness, no irritation. Am in my second of 5 years of letrozole—most bothersome side effect is a lowered metabolism without a lessened appetite, and a vicious sweet tooth. I can’t call the occasional mild warmth and slight night sweating “hot flashes” by any stretch of the imagination; and my joints don’t seem to be a problem (I take Tylenol at bedtime & Celebrex on arising). Had a R trigger thumb (resolved with a shot), but had two L ones years before cancer. Dunno whether it’s worsened my pre-existing osteopenia, or if the one Zometa infusion I had has slammed the brakes on that. Won’t know till my next bone density scan in Nov.—my MO says I can wait that long before deciding to try Prolia instead.

Could I have rolled the dice and done nothing after the lumpectomy? Sure, but with a life expectancy of 15-20 more years I wanted to do as much as I should to ensure that as few of those years as possible would be mets-free.

On another thread there’s a similar though neither age-nor-stage-specific discussion. I decided there’s sometimes a difference between “doing everything we can” and “doing everything we should.” With the former, I firmly believe that one can reach a point of diminishing returns that makes QOL impact untenable.