Choice of radiation and/or hormone after lumpectomy

FlorenceB

I'm 74, and had a lumpectomy last week-- tumor was 18 mm, ER/PR positive, stage 1c, grade 2. I didn't have the lymph nodes checked. I saw the oncologist today, who did not recommend hormone blockers, because of my history with intermittent depression and osteopenia. She assumed I would have radiation. The radiologist previously said I would not need radiation, because I would be on hormone therapy. She pulled up a chart which showed that either therapy gives you a 2 percentage point better survival rate. I'm wondering if I should bother with either. My main concern is that the hormone therapy might prevent future cancers. My inclination is to skip the radiation mainly because of the inconvenience, and try the hormone therapy and see how it goes. Any options or experience?

Salamandra

Hello,

Radiation therapy mainly helps prevent local recurrence, while hormonal mainly helps prevent both local and metastatic recurrence.

Hormonal therapy tends to be well tolerated across the board, while hormonal therapy is a crap shoot.

I wouldn't skip radiation for convenience. It is much less inconvenient than dealing with a recurrence, even if that recurrence is also caught early and does not metastasize. It is also much less likely to interfere with your quality of life (on a medium or long term basis) than hormonal therapy. Even many women who end up finding a dosage or brand or version of hormone therapy that works for them have to go through a period of trial and error and adjustment.

My understanding is that women over 70 now may be offered to skip radiation because they get less long term benefit from it (because their life expectancy is shorter). It wouldn't be crazy to skip radiation. But if it's really about convenience, I'd push through if you can.

Beaverntx

FlorenceB, I was 77, with a larger tumor than yours. Radiation was not difficult, got me out of the house every day (that seems more important after 2020 than it did in 2018!). I often ran errands after rads. On the other hand, the side effects of hormone therapy have been more of a challenge. That said I continue with anti hormonal therapy...

Best wishes in your decision making. I was not put on the position of having a choice but can imagine the challenges that creates.

AliceBastable

Is your health good otherwise? Do people in your family live into their upper 80s and 90s? I did radiation (33 sessions) at age 68 with no problem. My mother did radiation at 85, 33 sessions, had to drive every day to another town to do it, so she was very inconvenienced. But she lived to 97. Hell yes it was worth it.

FlorenceB

Thank you so much ladies. The people in my family do live to be in their 90's and my health is good --and I have 6 young grandchildren. The inconvenience of radiation is that I am caring for my totally disabled husband , but I can easily hire a caregiver and get out of the house for radiation and I only have to drive about half an hour to get to the facility. Now I'm leaning toward radiation and trying the anastazole too. I'll run it by my family members and PCP. It's funny how the specialists don't want to tell you what to do. I needed a pep talk.

MinusTwo

I did radiation in my 70s. Drove myself 45 minutes to & from every day for 5 weeks. I found it the easiest of any of the treatments - other than the fatigue. Just take the time to nap when you're tired.

MountainMia

When I was doing radiation, I shared the waiting room with a guy named Joe. Joe was a farmer in his mid-70s and lived about an hour away from the hospital. He actually was doing 2-a-days. He drove both ways twice a day, with his wife who had dementia and couldn't be left home alone. It was pretty damn inconvenient. He never complained.

Which is to say, if you can do radiation, please strongly consider it. It's a bit of a grind, but it goes pretty quickly.

Good luck.

FlorenceB

Thanks for the advice everyone. I'm doing radiation without any problems , and it's nice to get out of the house everyday. I'm thinking I'll try the anastrazole and see how it goes. I assume if you start taking it and have too many side effects, that they will go away after you stop? If I can prevent breast cancer, which could possibly lurking somewhere else in my body, it would be worth it. It takes so long and so much research to make these decisions.

AMG2

I'm planning on both, but I'm 57, and women in my family live into their hundreds. I think if you have trouble with one AI or tamoxifen, there are others that may be better tolerated.

Best of luck to you.