An interesting radiation study

http://www.medicalnewstoday.com/articles/255497.php

And here's an even more recent study that says lumpectomy and RADIATION had greater survival than mastectomy.

Can't look back! Base you treatment on the best available evidence and then move forward.

BCO posted a study in the articles section about how radiation improved recurrence stats by a small amount but did not improve overall survival because of the heart damage.

Radiation oncologists will give you a story on how the new radiation is targeted but it hasn't been around long enough to know if it's any better.

Hello-under alternatives, an Indian doctor at the VA asserts that a spoonful of the spice turmeric with a pinch of black pepper daily kills cancer stem cells. good luck!

Athena... Did you notice how far back the study went??? And the overall risk for a heart issue was still lower than for a cancer recurrance. When I read this article an hour ago, I thought it would raise some eyebrows. But considering that radiation treatment has improved over the decades, I would not give this study much weight.

Yes. This study is in line with other studies. But in no way is it saying that the risk of heart disease should persuade women to not consider radiation. What the study says is that patients who undergo radiation should be followed and maintain healthy lifestyles to minimize future cardiac risk.

Radiation therapy does not improve overall survival. It only helps minimally reduce local recurrence in the breast which nobody dies from anyway. When radiation began it was only studied head to head compared to mastectomy for five years. It's been around long enough now that we know the extent of coronary artery damage more than five years out.

BCO had an article about this. Nobody asks about overall survival. They're only told about recurrence.

We have an alternative forum here to look deeper into the standard recommendations.

Athena, thanks for the article. The studies, both the ones outlining heart risk and the ones giving limited benefit for rads, did concern me. In my case, however, my onc's reasoning was that I had "extensive" lymph and vascular involvement, and he had a strong suspicion that I had cancer cells hovering in the lymph nodes near the clavicle. In his estimation, the best way to clean those up was with rads. Without rads, they would be likely to lead to recurrence/mets fairly quickly. Furthermore the rads were on the right.

I do agree that it is good that the docs are getting better at managing individul risk profiles instead of doing one-size-fits-all treatment. In my particular set of circumstances, the risk of the cancer getting me was far greater than the risk of eventual heart disease. Since finishing treatment, I have been checked carefully by several cardiologists (I also had heart toxic chemo, yeah me!) and so far at least they tell me that my heart is in really good shape for my age, even without considering what they have put me through.

It is, however, an additional reason why I make sure to exercise, eat a healthy diet etc.

Thanks Voracious, Beesie and Momine. 5% benefit is significant to me and I will take it as I have no personal risk factors for heart disease.

There is NO 5% "benefit" for overall survival. That is a myth. Every article published has found that from the data.

The newer radiation techniques are still experimental. They haven't been around long enough to know whether they are any less lethal than the old ones over time. Even my oncologist acknowledgeded that they're still waiting for the data. But most people will go along anyway.

Hypothetically, if someone put a gun to my head and said you have to choose between radiation and garden variety chemo, I would take chemo because the effects are less damaging to the heart.

I realize it's very hard for people to accept that they have been misled after they have had their treatment. I wish I had a dime for every mistake I made by not checking the studies or understanding what the statistics meant.

This study appears to be quite big: https://iubcrc.iupui.edu/ccm/EBCTCG_XRT.pdf

It seems to conclude that rads drastically reduce local recurrence, with benefit in 15-year survival less, but still significant. I am good with having lowered my chance of having more cancer in the next 5 years, even if my long-term survival is not vastly improved. 

http://online.wsj.com/article/SB10001424127887324392804578358691452730124.html

"...Marisa Weiss, a radiation oncologist and founder of Breastcancer.org, notes that with state-of-the-art radiation equipment, "we can map it to the very millimeter." One technique called "respiratory dating" can monitor the position of a patient's heart with every breath and interrupt the beam momentarily when the heart would be most vulnerable.

Some centers are also radiating only part of a patient's breast, or treating patients lying on their stomachs, so that less radiation penetrates their hearts.

The accompanying editorial warned that the findings could be only the tip of the iceberg, since the study looked at only one type of heart damage—atherosclerosis—and radiation is known to damage heart tissue in other ways. And very few of the women were treated with chemotherapy, which can also cause heart damage.

Such research is contributing to a new area of medicine known as "cardio-oncology," the editorial noted, suggesting that cardiologists should be involved early on in planning cancer treatment.

Added Dr. Weiss: "The good news is that women tend to live a long time after a diagnosis of breast cancer, so the lingering side effects are very important."

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This article about the study is similar to others that say breast cancers survivors are living long lives and it is imperative to encourage them to live healthy lifestyles so that the small chance of breast cancer therapy doesn't create "issues" later in life for them.  It is nice to see that cardiologists are now being brought on board....

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A little off topic but also relative to this discussion is that many of you are discussing that these types of studies are questionable (myself included) and that we would all like to see more studies where the data is more relevant to our individual cases.  Why would I be interested in this study if they are determining my cardiac risk of radiation when they are including patients who had radiation more than 50 years ago?  And who EXACTLY are these patients and what were their risks of developing heart disease BEFORE they became cancer patients?   Pretty questionable IMHO.  And again, that leads me to once again to suggest that everyone read Eric Topol, MD's visionary book about the future of medicine, The Creative Destruction of Medicine.  In the book he is very critical of how we conduct trials and how we analyze retrospective studies.  He envisions more personalized studies, so patients can pinpoint their own risks and benefits of therapy.  How do we get there?  By using genetics and technology.  Clearly my genetic risk of having a heart attack and my lifestyle are not the same as anyone else's.  Using technology, biostatisticians can figure out precisely how healthy my lifestyle is AND using my genetics, they can compute my risks and benefits relative to other patients.  Example...Say I would score a "5" on a survey of lifestyle..."0" being a couch potato and "10" being a Jack Lalanne.  And then say I score a "5" on my genetics, again "0" representing people who have family members who all died young of heart events and again, "10" being a Jack Lalanne, whose family all lived to die in their sleep well past the age of 90.  When the biostatisticians crunch those numbers, then they would come up with a more individualized number for me and then I could see from the numbers presented in a radiation study EXACTLY how much of an increased risk I would have from that particular therapy.  I could also figure out how much benefit I would have from the therapy as well.  With tests like the OncotypeDX score, we are beginning to see more individualized information.  Hopefully in a few years, we will no longer be reading studies like this one.  I envision, one day soon, that we will be able to laugh at how "primative" these types of studies were.

Voracious, good points all.

I keep trying to post the link to the Canadian study (July 2011) results, but am having difficulty.  Basically what it stated was that - in a study of nearly 1,800 women with early-stage breast cancer with one- to three positive lymph nodes who underwent breast-conserving surgery (lumpectomy) and received both chemotherapy and endocrine therapy - adding additional (i.e., Regional Node Radiation) radiation therapy to the mix improved survival outcomes.  One group in the study got Whole Breast Radiation only, the other group got Whole Breast Radiation + Regional Node Radiation.

At five-year follow-up, interim analysis showed a greater than 30% improvement in disease-free survival for those receiving Regional Node Radiation.  This resulted from a 41% lower risk of recurrence in both the breast and regional nodes and a 36% lower risk of metastatic disease between the two groups.  (Keep in mind that these are numbers generated from the study demographic and are not absolute.)  Adding the additional radiation resulted in a low, but statistically significant risk of pneumonitis and lymphadema.  Other toxicities were not significantly different.

When I questioned my treatment team about this option, they said that the percentages I was looking at was a 4-6% increased benefit against local disease and a 2% benefit against metastatic disease.  This finding surprised them because it was long thought that Regional Node Radiation only provided a local benefit and this study showed that it, actually, helped prevent metastatic disease.

Does radiation have risks?  Yes.  But those risks are far out-weighed by the benefits.  The risk of developing breast sarcoma in the radiated breast is minimal.  The risk of cardiac problems is, also, minimal and tends to be far greater in those who already have heart problems.  Ditto with lung issues.  That's why if you have pre-existing heart issues or lung issues, radiation may not be for you.  But it doesn't mean that radiation may not be right for someone else and that - yes  - it can- and will save their life.

RADIATION DOES NOT CAUSE CANCER OR HEART/LUNG PROBLEMS IN EVERY PERSON WHO HAS IT.  Just like aspirin does not cause Reye's Syndrome in every person who takes it.  If it did, it would not be used as a treatment.

Everything has risks.  That's why we have treatment teams.  They sort out our medical histories, analyze our breast cancer tissue, put it all together and determine whether- or not the risks out-weigh the benefits on each individual case.  If a recommendation is being made for a particular form of treatment, then there are, usually, sound scientific/medicals reasons for it.  Oncologists are not in the business of trying to hoodwink you or force you into treatment that may not help you.  They will, using their knowledge and experience, try to design the best, possible treatment protocol for YOU.  If you don't like what they are saying, that is up to you.  But, making sweeping statements that IT WILL ALWAYS KILL YOU is not only wholly inaccurate, but it's terribly misleading.  If that were the case, then every single solitary woman who underwent chemotherapy and/or radiation would die of heart/lung disease or another form of cancer.  And that, simply, just doesn't happen.  Period.

Our bodies are complex mechanisms.  Breast cancer is a complex mechanism.  What works for one person will not work for another - not because it will, eventually, kill you - but because science hasn't worked out how to isolate each different piece in the mechanism and tailor treatment to the individual.  Science is doing better, but it's going to take awhile.  In the meantime, everyone needs to make decisions based on what is right for them.  THERE IS NO RIGHT ANSWER TO THIS ISSUE.  But telling other people (especially those who have been newly-presented with the option of radiation based on THEIR situation) that radiation kills (or that chemotherapy kills) without qualifying your information (yes, it can be dangerous under particular, well-defined circumstances, but extremely beneficial and life-saving under others) is simply failing to grasp the complexities of the issue.   Not to mention being a little short-sighted in the sensitivity department.

The risk of dying of a radiation heart attack is low.  Does it happen?  The possibility is there that for someone who already is having heart issues or who has undiagnosed heart issues this could happen.  But it is very rare.

Before starting radiation therapy of any sort, it is standard (at least in Ontario) to undergo a complete physical work-up with emphasis on heart and lungs.  If any issues arise from this work-up, it is possible that radiation may be taken off the table for YOU.  But for someone who has a perfectly healthy heart and lungs, the risk of developing a radiation-induced heart attack is very rare.

This is what I mean by qualifying your information.  There are no absolutes in this world, especially when dealing with cancer and to use absolutes as fact is misleading.  The human body is not an absolute mechanism.  Cancer is certainly not a absolute mechanism.  There are things we can predict about both, but we can only predict the relativity.  To grab on to absolute number skews the real situation.

Edited to add...

I am deathly allergic to penicillin.  It will kill me.  But millions of other people can take it safely and it saves lives.  Does this mean I tell people, oh, DON'T take penicillin IT WILL KILL YOU?  I wouldn't think of it.  Not everyone is allergic, moreoever, those who are allergic are allergic to varying degrees.  This is relativity.  An absolute conclusion would not only be inaccurate, but it would deny all those who could be helped the opportunity to make their decision knowing that - for them - penicillin will, probably, not kill them.  For them, the benefits of penicilin will FAR out-weight the risks, and going without it might under certain, dangerous circumstances cost them their lives.

The same is true for conventional cancer treatment, as well as holistic/natural cancer treatment.  It is relative.  It doesn't work for everybody.  Some people have good experiences, some people don't.  Some treatments have better track records than others.  Some treatments have compelling- but anecdotal evidence only.  Personal beliefs - in my opinion - are perfectly acceptable for the person who harbors them and their reasons for coming to those beliefs are valid.  Hopefully, the person has weighed the pro's and con's and made a good decision for THEM.  Again, it's a relativity thing.  What I object to are those who insist on casting everything in absolute terms based on their beliefs, especially when they cannot provide consistent- and compelling evidence that the source(s) sited critically evaluates both the advantages/disadvantages/risks/outcomes and realities/limitations of the source material.