Questions about radiation in early stage IDC

Rushing in here....didn't have time to read all the responses but simply put:

If three women are expected to have recurrence with no radiation, and with radiation, two have recurrence, then the number they tell you is that with radiation there is a 33% reduction of recurrence.  A "rubber" number that can be misleading because it speaks to the general population of breast cancer patients, not your particular percentage.

MHP, I think you're asking all the right questions.  As for delayed recurrences, it is true that er+ bc can recur many years, even decades later, but that is not when most recurrences of even these cancers happen.   By 5 or 6 years the risk of a recurrence drops to about 4%.  But that risk remains for a lifetime, while with triple negative bc you can pretty much assume thats the finish line.  I just don't want folks to think that most er+ bc recurs so late -- that is actually relatively unusual.  As for her2neu+ I wonder if that stat has changed with the widespread use of herceptin, a relatively new development.

I've wondered...why haven't the insurance companies used these studies (that radiation therapy doesn't show an overall survival advantage and relative risks versus absolute risk factors that show an individual "rubber" number as not being beneficial) in denying people expensive radiation treatments like they do with other treatments?

mollyann,

They still are paying for chemo for those like me who are in the gray area. What I find frustrating is seeing how many of us who a year ago would not be facing chemo are facing  now because of the oncotype test gray area. There gray area has also moved from 16 to 12 which includes so many more women in that gray area.

Karen

Designer, I wanted to share a story since you are seeing your RO. When I was considering rads several years ago, someone pointed me Fisher's work on the NABBP. So I brought it to the RO.

The RO said, "you have it backwards. Of course, there's overall survival." I was mortified because I had stayed up the night before highlighting the salient parts with a marker. Honestly, I still remember, my face getting hot with embarrassment. How could I have been so wrong? He said my breast would get red but nothing to worry about. My husband was with me and he remembers every word just as I did.

Then by accident, I ran into my onc in the supermarket two hours later. I told her the story. She said that I must have misheard the RO and there was no overall survival value and they had known that for years from Fisher and other studies. They only like to do rads on the chance it will help with local recurrence.

So, good luck, honey and don't let your RO intimidate you like mine did me!

This article compares the doses to the lung and heart for 'prone' positioning (face down) and 'supine' positioning (face up) during radiation.  

 http://www.ncbi.nlm.nih.gov/pubmed/20561695?dopt=Citation 

"Conclusions: In the context of tangential-field WBI and PBI, prone positioning is likely to benefit left-breast-affected women of larger breast volume, but to be detrimental in left-breast-affected women of smaller breast volume. Right-breast-affected women are likely to benefit from prone positioning regardless of breast volume."

Has anyone heard about this?

Back from meeting with my RO.  I brought up the Fisher study questioning whether there was any benefit to radiology after lumpectomy.  My RO, who I respect and like a lot, he never tries to strong arm me into any decision, said "Oh, I know Bernie (Fisher) very well, he NEVER said that there was no benefit.  Recently they have documented that there is definitely benefit to radiation after lumpectomy".  Small world!  He mentioned an update in  the Lancet.  I googled that and came up with this article which clarifies that there is survival benefit.  I think it says 5 more women out of 100.  There is also a link to the Lancet article if you want to read the detail. http://health.dailynewscentral.com/contentview/2019/63  As I did have one positive node, I knew I would do radiation.  We are now trying to decide whether I will do it sunny side up or down.  Mine is left sided and I am concerned about heart and lung damage.  He said that we should look at everything once I get the CT to determine how close to the heart the radiation will be.  All these treatments are such a personal decision.  For some 5% benefit might not be a lot.  For me, 5% sounds like a definite benefit.  I think it is great that we can all discuss the many aspects of all these treatments, it helps me so much.

I would be shocked if the number of women dying from cardiac damage from radiation is anywhere near 5 in 100.  Since Fisher himself is apparently saying there is a survival benefit, and this study demonstrates it, I don't understand this effort to create arguments that this benefit doesn't exist.  Seems to me the appropriate response to ask if the benefits are worth the risks, like with any other cancer treatment.  But to deny that they exist doesn't make sense to me.

MOC, where did Dr. Fisher say there is an OVERALL survival benefit?. Are you drawing your conclusions from a hearsay conversation from somebody who sells radiation?

I would like to read it, first hand, where Dr. Fisher has reported evidence there is no overall survival benefit. Please cite a source. Thanks!

Until then, the study going out the longest, is the most reliable. Also, I think you are confusing breast cancer survival with overall survival.

Member of the Club-  I probably wasn't clear in my post.  I am actually saying that there IS a benefit of doing radiation after lumpectomy.  The 5 women out of 100 was quoted in the article as 5 additional women surviving because of the radiation received.  It was not a statistic about heart damage.  I am only expressing my concern about the possiblity of heart damage.  My Onc said that on left sided BC radiation,  3% - 4% can end up with heart damage. And this heart damage would probably not be apparent till many years later. He did think we could reduce that once he looks at the scan.  If I am a candidate for the sunny side down technique, that would reduce the heart and lung exposure more.

From what my Onc said, who knows Fisher,  the newest conclusion with additional data say there is definitely a benefit to doing radiation.  I believe he said that there didn't appear to be much difference up until women were 50 and then there is a dramatic trajectory of benefit that is demonstrated.  I'm going by memory, so this needs to be verified.

Karen, what is this about the gray area of the oncotype test now starting at 12?  I hadn't heard about that until reading your post.  I thought I was well out of the gray area, my score was 14.   I was diagnosed 2 years ago and feel very fortunate that I was able to skip having to do chemo.  But if what you said is the new standard, had I been diagnosed recently, might my Onc now be recommending chemo for me?