Radiation necessary in an early stage cancer

Thanks Tender for that info.

I guess I  still think of an Early Stage as being  No Node Involvement.

And was wondering if one gains the same benefit of helping to prevent Mets.  If they are Node Negative.  Have had BL- but no Rads.

Pam

mdb,

In the particular case of my dh grandfather, he had a recurrance.  Period.  When a person with bc has a recurrance and had the area radiated in previous treatment, they cannot re-radiate the field.  Therefore in his case,(remember 25 - 35 years ago) the treatments available for him did not work (I do not have the particulars of the treatments that he had as we were in another state during his treatments - we were there for the end).  Thank you for the link, however, in his case the recurrance killed him.  And it was not pretty to watch (cancer never is though).

 Gentle hugs to all,

Trish

Hi Dejaboo, I just love that name and your dog, so  adorable, I was answering Laura, did not see your post.

Hugs, Shirlann 

Oh Pam, honey, for goodness sake, no offense taken.  This damn journey is a hard frickin' road, just wears you out.  Sometimes it is just too much.  But I can see that wonderful dog is a hoot!  I showed him to Walt and his "oh so darlin' name", sheer genius!  My dear sister.

Hugs and kisses, Shirlann 

Ty!

Laura

Shirlann,

 You have been such a calming voice in my journey.  You were one of the first ladies that I read on these posts and I admire your spirit.  Thank you for considering me as someone you call your sister, I only hope I earned the right to be one.  There are times where I am so angry and cannot deal with this - but that's for another thread.  Hugs to you Shirlann.

Trish

I am responding to Jaydee's posting on July 1 'I was reassured by the fact that where I was treated (UK) they do have a policy of weekly meetings where the medics put their heads together to decide on the best treatment for a particular patient.. I just feel that if you have the collective opinion of the medics to follow a certain route and discuss the reasons for this it would take a great deal of consideration to disagree with them.  I had a couple of weeks to consider whether to have rads.  Money is tight under our NHS system so you are not so likely to be given unnecessary treatment!'.

 Even though there is a policy of weekly meeting I do not think that too much thought is given to individual cases.  They still seem to follow 'radiation therapy for anyone with lumpectomy regardless' protocol.  I have just had my third treatment and am having quite a strong reaction: very tender whole breast, nipple and scar areas as well as tender ribs with pain when I take deep breaths.  I expressed my concerns and they were all disregarded.  I was told that it was probably due to my activity levels and when I said that I had not been active was told that it was probably then due to my bra (which by the way is very old and very loose and most comfortable one I could find).  I definitively did not feel heard and only because I pressed very hard about being concerned with the extent of side effects this early in the treatment and whether this was an indication for long term damage I was offered an option to meet with the consultant (who prevously met me for couple of minutes only).  I also think that money is still very much the object even for the NHS (British National Health System) as all departmetns have budgets which they have to balance.  I have learned (unfortunately not from consultations with doctors but from forums like this one) that there are different options but they may cost more and are not being offered.  Most of all I think that in order to save on consultant's time it is very much 'one size fits all'.

You know one thing I really dislike about your posts, besides your arrogant  ignorance, its that you almost blame the breast cancer victim of being the cause for their own cancer.  If only they were smarter and read up on the right foods to eat, etc., that they never would have gotten cancer.  Well you are simply full of ****.  My wife is young, has exercised forty five minutes every day on an ellipitical as well as going to the gym three days a week for strength training, eats moderately and well, paid oogles of money for supposedly nutritional supplements and she still came down with cancer.  Did she ever bother going to the alternative websites to follow the advice of quacks?  No.  But she followed all the advice about eating well,exercising, etc.  AND STILL GOT CANCER.  You r generic anti-western medicine campaign here is getting old and anybody who would be foolish enough to take your advice will be placing their life at risk.

Sorry, I was not clear.  NHS is completely free for users but all health departments have budgets which they have to balance.  There is a government body called NICE which advises and regulates what can and cannot be offered on the 'value for money' basis.  So, I guess, if it is more costly to use MRI scans and employ more consultants to evaluate and follow up each patient carefully than 'one size fits all' is used.  As I said the consultant I was allocated to saw me literally for two minutes (the rest was done by junior doctors, nurses, technicians).  I haven't seen Sicko but was told that NHS was idealised by Michael Moore.  For example preventative care on the NHS is very poor.  We are not entitled to mammograms until after 50 and I had a job persuading medical professionals to offer me one.  I guess it is still better than having to pay for treatments.

Worried hubby: I understand your concerns and anxiety about your wife's health but think that all opinions are welcome as we only get one side of the story from the medical establishment.  As you know things are not clear cut and people who go down the medical route still get recurrences and even die so it cannot do any harm to be informed of all possibilities.  For me, personally, it is reassuring to hear stories of people who have tried something different and done well but at the same time there is no need to blame anyone for the choices they make.  This is one of those where you can be 'damned if you do and damned if you don't' choices.

MDB I have found book 'Your life in your hands' very informative in terms of minimising the risks of it coming back.  It is written by a British scientist Jane Plant who has had five recurrences until she made lifestyle changes most notable one being complete avoidance of dairy food.  It is a shame that Dr Plant charges people for using her internet site but the book is definitely well researched and documented.

I tried so hard to stay out of this. MDB, I  appreciate where you are coming from, but a one-size-fits-all approach on EITHER side does nothing. No rads all the time vs. Rads all the time - Eh. We all make decisions based on our own risk tolerance, consultations, research, and so on. It is an individual decision no matter which way you look at it. No one told me what to do, there was input, second opinions, discussion, research, and finally, an informed decision, which should be the case for everyone.

That said - Please, unless you are a medical professional with the appropriate qualifications, DO NOT presume to tell me that DCIS is NOT cancer. My doctor said so, my surgeon said so, the oncologist said so. DCIS is not invasive cancer, but it is cancer nonetheless.

thank you for your consideration.

Hi all, again I have to say, money does not drive this suggestion of radiation, statistics do.  In California we are all (almost all) on HMO type insurance, they MAKE MONEY when they do not treat you.  Just try and get an MRI or to see a specialist.  It is like pulling teeth.  Medicare sends the group you belong to $5000 a year, if you don't go near them, they keep all the money.  ERGO, they sure don't ever ask you or urge you to have radiation unless they think they are going to be sued, if they don't.  For example, I had NO follow-up care of any kind.  Just mammo's, and the military, which is huge in California, is the same way.

I had to argue like a Dutch uncle to get a colonoscopy. So please don't be sure it is money that always drives radiation recommendations.  Because that is just not true.

Let's get that argument off the table, once and for all.

Hugs, Shirlann

PIP, sometimes women end up with stage IV disease despite having been declared node negative because they had a blood vessel invasion - though the lymphatic route is far more likely to be the culprit (>90% of the time).  There probably isn't much about the basic mechanisms of metastatic BC spread that isn't already known - cancer spreads from the primary site most often through the lymphatic system and occassionally directly through the blood stream. There really is no other way for it to get to distant organ systems.

Occassionally, nodes are declared negative when they're actually harboring occult micromets that are never identified. So though they're thought to be node negative, they're actually not, and that's explains how they eventually can up up with, seemingly out of the blue, stage IV disease.  Occassionally, lymphatic and/or vascular invasions are missed in the pathological tissue exam. As patients, we would all like to think that there's never any error or failure to identify lympathic or vascualr invasion, but unfortunately that's not the case. There's no 100% guarantee or accuracy in anything. Occult local or distant metastatic disease is not all that frequent, but it happens more often than anyone would like to acknowledge - and not just with breast cancer either. There are women out there who get diagnosed with metastatic breast cancer right off the bat, and despite an exhaustive search for the primary tumor, none is ever found...yet they definately have metastatic breast cancer with not only negative nodes, but also no identifiable primary tumor.

The fact remains though, that the threat in cases of DCIS where the nodes have been checked and found negative is minisule. The only way anyone is going to develop metastatic disease from DCIS, is if it's not really just DCIS at diagnosis or it's not resected completely and progresses to invasive disease later on.  Again, there are instances where things are missed and overlooked...in which case it's no longer just DCIS, it's invasive breast cancer. If there's even the tiniest little bit of invasive disease present and especially if it happens to be high grade and aggressive, then it's possible that someone could eventually end up having distant metastatic disease. Pure DCIS with no invasive component at diagnosis carries absolutely no threat of metastasis once it's been surgically removed with wide, clear margins.  

Early stage breast cancer is a very different story because "early stage" encompasses a wide variety of differences in tumor sizes, node and Her 2 status, grades, and hormone receptivity.  Some early stage cancers are low grade, non-aggressive and very unlikely to be node positive, occult or otherwise, even if the tumor happens to be relatively large. Other early breast cancers are high grade ( some 2's and all 3's) and often very, very aggressive - and these are the ones where you really need to worry most about what's happening in the nodes. These high grades are the ones most likely to harbor an occult disease in a node and/or have vascular invasion and therefore are primarily what women have who develop distant mets after being declared node negative.  

Marie,

That is my point. You say that chances of being diagnosed DCIS and having mets is miniscule.  Maybe that is true....unless it happens to you.  There are many of us here who can tell you stories of biopsies showing DCIS and then the pathology from surgery says otherwise.  And there are many of us who have been blindsided when surgery finds several more areas than were previously seen on the scans.  Why does it seem so unthinkable to you that some, maybe many, of the followup tx  never reveals what is truly in the breast. 

It just seems strange to be so suspicious of the docs wanting to do rad tx for $ and then, on the other hand, putting so much stock in their tests and reports that you are willing to forgo the recommended tx. 

Wow, Mariekelly...maybe you should tell that to all the scientists who are still studying how and why metastasis occurs. Sure would save them a lot of time and $$$