For those age 60 or older, early stage bc, considering treatment

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AlaskaAngel
AlaskaAngel Member Posts: 1,836
edited June 2014 in Stage I Breast Cancer

http://jnci.oxfordjournals.org/content/early/2011/08/31/jnci.djr299.abstract 

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  • MarieKelly
    MarieKelly Member Posts: 591
    edited September 2011

    So, older women with small, grade 1 tumors have traditionally been been overtreated for nothing. What a shame it takes so long for these kinds of studies to produce results..and when they finally do, it takes forever for them to be acknowledged and for standards of care to change. For goodness sake - you don't even need studies to tell you the obvious. These kinds of tumors in older women are not life threatening.

    When I think of how many older ladies have been subjected to the side effects of treatment compromising their quality of life it makes me want to scream. And how much longer will the overtreatment continue? Many more years, I'm sure. It's so sad.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited September 2011
    MK...I noticed that the moderators also posted this meta-analysis study and when I read it...I was thinking of you!Laughing  I don't think this study is going to be a treatment protocol changer.  I think doctors are going to continue to offer treatment.  You have read the NCCN guidelines...they wiggle around by saying "consider" therapy....
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  • ICanDoThis
    ICanDoThis Member Posts: 1,473
    edited September 2011

    The conclusions of this study are really important:

    Conclusions A small subgroup of breast cancer patients who were 60 years or older and had hormone-responsive early-stage tumors up to 10 mm, and received no systemic adjuvant therapy, were not at increased risk of mortality compared with women in this age-group in the general population.

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  • ICanDoThis
    ICanDoThis Member Posts: 1,473
    edited September 2011

    I think this study is really important, because we have been talking intensely about whether or not  early detection, particularly in women over 60, can actually effect a cure. It sounds like this one subgroup is in fact cured by conventional treatment, and needs no further treatment.

    Unfortunately, this wasn't me, but for a woman who never had a mammogram before diagnosis, and who has never had a screening mammogram, I got pretty damned lucky. 

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  • mkwek
    mkwek Member Posts: 2
    edited September 2011

    Hi everyone,



    My mum is 60 and just discovered she has stage 1 breast cancer, grade 3 tumor, ER+1/PR-, HER -. The tumor is 1.5cm by 1cm. Lymph nodes are clear and PET scan also clear. She is also post menopause. she had the tumor moved 2 weeks ago and did a breast conservation surgery.



    The oncologist recommended for her to do TC chemotherapy 4 cycles, followed by hormone therapy (arimidex) and radiotherapy. We're all reeling from this recommendation to do all 3 treatments notwithstanding that she is stage 1 and everything.



    Wen don't know if she should do the chemotherapy or not and everyone is really having so much anxiety over what to do. The oncologist didn't really make it sound like it was an option for my mum not to do chemotherapy.



    Any thoughts or experiences is greatly appreciated! Thank you.



    Melissa

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  • MarieKelly
    MarieKelly Member Posts: 591
    edited September 2011

    Melissa, this study suggesting some 60 and older women don't really too much treatment is talking about only a certain group of these women - those with small tumors who are grade 1. Your mother has a larger tumor and is grade 3 with low ER positive and negative progesterone  hormone receptors.  She does not fit in this category of women as her risk of both local and distant recurrence is higher - even without havng any positive nodes at diagnosis and even being just stage 1.  Has your mother had an oncotype test done? If not,having that done would probably help clarify her risk for you and assist in making treatment decisions.

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  • mkwek
    mkwek Member Posts: 2
    edited September 2011

    Hi mariekelly,



    No oncotype test done. I only just learned about this test today while reading through the breast cancer.org website. Her oncologist didn't mention doing this test.



    I'm planning on asking for the oncotype test to be done but does anyone know if the recurrence score is only in relation to recurrence in the breast or recurrence anywhere else?



    Thanks so much.

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  • DocBabs
    DocBabs Member Posts: 775
    edited September 2011

    I knew somewhere along the line I'd run into an article like this.I hemmed and hawed about starting Arimidex and finially got to the point where I was comfortable with the decision to take the stuff and now this.!! I had LCIS for 3 years before my latest diagnosis and was repeatedly  reassured that it was NOT a cancer and that the chances of it becoming one were small.In my case it turned out to not be so small and that's the problem. Would I be one of those in the group that went on to live a nice life with no reoccurance or would I end up with mets? And then what ??? As I said I started the drug and I've told my husband that if any sid effects occur that I found objectionable or life altering, I'm off the stuff. So far there's been nothing.I am most concerned about bone density. I'm a tennis player and right now my bone density is very high. I've decided that if I have a 5% or more drop  I will stop.I have 3 artificial joints and can't afford for my bones to get soft!

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  • AlaskaAngel
    AlaskaAngel Member Posts: 1,836
    edited October 2011

    Association between tamoxifen and diabetes for older women:

    http://onlinelibrary.wiley.com/doi/10.1002/cncr.26559/abstract  

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  • bluepearl
    bluepearl Member Posts: 961
    edited October 2011

    I read this article as well. One has to remember that sometimes, and it's a small percentage, even small, low grade tumors can "drain" into the internal mammary glands exclusively (node negative in armpits) I looked it up for women 60+ and it was something like 6%, higher if you are younger, higher if the grade and size are.  These internal mammary nodes are never tested. I brought this up to my doctor and he said that's why you are on tamoxifen...to starve any micro mets that might be lurking. I have the additional worry of having had two atrial fibrillations within 6 years which by themselves carry a stroke risk never mind that is also a risk being on tamoxifen but my doctor said he couldn't answer if that was a risk or not if I had another while on tamoxifen. No studies.

    According to John Hopkin's University, exemestane is a safer AI than most with few side effects. So, am considering two years on tamoxifen and three on exemestane to reduce either's potential risks. I don't know if I could stand the worrying about recurrence or the worrying about SE!! I also read about fatty liver disease with tamoxifen *groan*, now diabetes???  I guess what it means too is to EAT right and EXERCISE, like AlaskaAngel is doing. 

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  • dimdame
    dimdame Member Posts: 14
    edited October 2011

    geez, what do us do with no tumor? Just with one lymph node...

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  • jacee
    jacee Member Posts: 1,384
    edited December 2011

    bluepeart- I had a 7mm tumor, Grade 1, located on the outer side of my rt breast. My SNB showed I had 2 sentinel nodes....one axillary and one internal mammary node. My surgeon removed both and both were positive. I was shocked to learn that my tumor had a sentinel node that was all the way on the other side of the breast in the IM node chain!! I'm so glad my BS removed the IM node, as both nodes turned out to be positive.  Very unusual for such a small, low grade tumor to have traveled and spread to these nodes.

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  • Kaara
    Kaara Member Posts: 3,647
    edited December 2011

    AA:  Thanks for posting the article.  I am convinced that I would be taking a greater risk by taking any treatment post surgery for my small stage 1 cancer.  I think doing nothing could be a risk as well, but by staying on an anti cancer diet, taking supplements and antioxidants that boost the immune system, and doing regular testing with thermography, I can stay on top of any recurrance.

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  • AlaskaAngel
    AlaskaAngel Member Posts: 1,836
    edited December 2011

    Kaara,

    That is why I suggested to the Mods that it might be really helpful to include either age or menopausal status as a characteristic specifically listed as part of the signature, but they suggested instead that people put that info in separately. It is well known that the vast majority of breast cancer patients are diagnosed after age 60. 

    It may be that there just isn't the capability to add another category of information in the signature. I do think, however, that the lack of that information as a rule is actually very problematic in that because most people who post do not indicate their age and/or menpausal status, the vast majority of breast cancer patients (those over age 60) aren't able to distinguish meaningful information about treatment for their situation and end up confused about it, and generally overtreated as a result. The older and more menopausal one is, the less likely there will be recurrence and the more likely one will suffer SE's, and to a greater degree. Since they ARE the majority of breast cancer patients, that personal info is especially important.

    A.A.

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  • Kaara
    Kaara Member Posts: 3,647
    edited December 2011

    AA:  Very good point.  If one doesn't do any research, then there would be absolutely no idea what applies to post menopausal women...it would be left up to your doctor's discretion, and I already know what that would be.  When I showed mine the study, first he denied it was for 70+ (thought it was 75) and then said it was for women who were frail and unhealthy (of which I"m not).  My thought was that if I do rads, I will become frail and unhealthy in short order!  I'm meeting with two oncos just to see what they have to say and to challenge their theories about treatment.  It probably won't be pleasant, but I like to hear all sides of a controversy.  I'm also not going to take the anti hormonals.  The SE's from those sound awful as well.  I value my QOL over longevity.  

    My integrative doctor is doing a great job of seeing to my ongoing health with the proper diet and supplementation program, as well as recommended testing with thermography on a regular basis.  I am more comfortable with this treatment program than I would be with chemo, rads, or hormonals.  I don't see it as any greater risk than being poisoned or burned.  From everything I've read, there are no guarantees either way, so I am making the decision that I feel is in my best interests.  I would not recommend it for anyone else.  Everyone should be their own advocate and do their research.

    One thing I would add....doing nothing should not be an option.  If you are going to avoid conventional treatment, then you absolutely must follow an anti cancer diet and supplementation program which takes a huge committment of time and money.  Insurance does not pay for holistic or integrative treatment in most cases, and the cost of eating organic is about 30% more than eating conventional...sadly!  

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