An interesting radiation study

NattyGroves... I do understand the "absolute risk" and "relative risk" calculations.  I do know what a scientific metric is.  What I am objecting to - and what you fail to grasp - is that brandishing that scientific metric to support a personal viewpoint, i.e., radiation will kill you, chemotherapy will kill you, or - even - natural supplements will kill you, is - in my opinion -  disingenuous at best and outright deceptive at worst.  It is bias, not a scientific metric.

And the fact remains.  Radiation-induced heart attack is a very, rare side effect.  It can happen.  It usually doesn't.  Ergo, it's not an absolute and should not be presented as one.  And, just to be really clear, it's not your beliefs or information that I object to.  Information is information.  Fact is fact.  It's in interpreting the information to conform to your viewpoint that I'm questioning.  And, although your viewpoint is valid, camoflaging it as absolute fact is not.  There is a risk.  That risk is minimal.  The risk increases if other risks are present.  These facts are undeniable.  Presenting these facts in such a way as to suggest that the risk is far greater than it is, is a mispresentation of the facts.

Considering I spent several years providing statistical analysis in the medical research lab of a pharmaceutical company, I find your suggestion that I don't understand the models completely hysterical, LOL!   Yes, you do like to make sweeping assumptions based on your "facts", don't you?  You've proven my point far greater than I ever could.  And you've just made my day.  You're quite amusing and I wish you the best too.

Natty, an absolute reduction of risk of recurrence in the next 5 years by 19% is significant to me, even if it carries a moderate increase in the heart attack risk between now and age 80. If I am felled by a heart attack when in my 70s, caused in part by the radiation I had last year, I will consider myself extremely lucky.

I fully understand that for someone else, the risk calculation could easily look very different.

VR, Selena and Momine, good information!

Natty, you said:

Radiation is given to prevent a small chance of local recurrence in the breast.

The options are:

A: radiate the area and risk permanent heart damage

Or B: Remove the breast and have no heart damage.

Well, I guess it's a question of picking one's poison.

With rads, one faces a small risk of heart damage as well as a small risk of a few other longer-term side effects. 

With a mastectomy, one faces a 100% risk of side effects such as loss of sensation and numbness, and a more moderate but still significant risk of other physical side effects, such as neuropathy. 

I had to have a MX - no choice about it because my area of cancer was too large - but if I'd had a choice, I would have much preferred to have a lumpectomy + rads. After seven years living with the MX, I would still choose a lumpectomy + rads over a MX.  In small ways, my MX is noticeable to me every day of my life. With a lumpectomy + rads, the odds that I would still be thinking about having had the lumpectomy + rads or dealing with the side effects 7 years later would probably be 5% or less.

Now, back to what you said:

Radiation is given to prevent a small chance of local recurrence in the breast.

The options are:

A: radiate the area and risk permanent heart damage

Or B: Remove the breast and have no heart damage.

What you presented is not the whole picture. What if the risk of local recurrence isn't just a "small chance"? Everyone's recurrence risk is different. On average rads reduces recurrence risk by ~ 50%. I would agree that's not much of an absolute benefit if someone has a recurrence risk after surgery of only 6% (for example). But what if someone comes out of surgery with an estimated recurrence risk of 25%?  That's not unusual. 

And what about those who require rads even after a MX?  Often this isn't known until the surgery is done.  Over the years on this board I've seen quite a few women who have chosen to have a MX so that they can avoid radiation, only to find out after surgery that they need to have radiation anyway.

This is a complicated issue and a tough decision.  In the end, we have to pick the option that makes us the most comfortable or scares us the least.  There is no one-size-fits-all answer.  I didn't need to have rads after my MX but I did have to make a similar decision about Tamoxifen.  For me, the absolute benefit was not worth the risks associated with taking Tamoxifen so I opted out. But I would never suggest that Tamoxifen is a bad drug or that it should be avoided by everyone. For women who face a greater risk of recurrence, the risks from taking Tamoxifen might pale in comparision to the benefit that they'll get in terms of recurrence risk reduction.  It's the same with rads.

They don't miss the heart completely - some radiation does get there, but far less that in the past. You aso have to contend with the uncertaintes of human error in the operation of the equipment - human error is quite common in these cases.

For me, mastectomy was a great choice (despite the huge human error component - I was lucky to have a superb PS and I knew my body enough to know that I do very well in surgical interventions generally - which is not the case for many others). I faced a 100 percent "risk" of smaller breasts, making me feel and look nicer in clothes. I hated the feeling of the dangling breasts - they made me feel old and ugly -  and that is now lost. Smaller breasts were a psychological boost because they made me feel that I was in control of my sexuality - not some misshapen c cups. The mastectomy and reconstruction were two good, positive and enjoyable aspects of cancer for me. Plastic surgery for a copay! It was an unexpected bonus. Also, for some reason surgery seems to be very good for my skin - probably the IV fluids coursing through one's veins for hours.

Radiation also carries the risk of lymphedema, which for those who have the disease is a huge QOL problem even if it's not fatal. A few people are on disability due to it though.

There are many things to consider with radiation. For me it made no sense. YBMV (Your Body May Vary - especially if you are stage IV and need radiation for visible tumors, rather than the "just in case" variety that early stagers get.) 

Rdrunner, before you hold your breath for that long, you may want to ask if the machine they're using uses resperatory gating software--if so the software would do the work for you and you could breathe freely

Diagnosed on Valentine's day and biopsied same day, I had first lumpectomy Feb. 20 and second lumpectomy yesterday to get better margins and temporary balloon implanted for internal radiation. My tumor is 1 cm, grade 1, with no lymph nodes. Today after CT at Radiation Onc. office they said the breast surgeon left cavity too large and Internal Radiation might not be possible now because of the potential damage to chest wall and rib cage. I don't understand how that kind of important information was not passed from the R.O. to the B.S. and now that I have been reading this thread and the radiation study from the link above, I am beginning to think I may forego radiation and tamoxifen altogether and just stop eating sugar, eat a lot of brocolli sprouts and flax seeds, and get on with my life. Thank you for all of this information, ladies. You all rock!

I have opted in to a clinical trial for partial breast radiation, 2 x a day for 5 days. I met all of the criteria - > 50 years old - margins >2mm - lesion smaller than 2 cm - lumpectomy only - no previous rads - stage 0 or 1 with no nodal involvement. So, I signed up! It is my left breast so I am happy that my heart and my lungs will be out of the field as they only radiate the lumpectomy site and 1 cm all around it. I was nervous about rads for the heart reasons. This was optimum for me since most recurrences are right in the same area of the lumpectomy site. With stage 0, I knew it was a no-brainer for me.

I had gold seeds implanted around the lumpectomy site via a needle (they are called fiducials or something like that) and the rads are drawn to that area. I have to have a CT scan daily (not a full radiation type but a modified one) so they even take my breathing pattern into account and pin point the rads. I am confident that they will get it right. I am at Yale and they are an excellent facility.

Just thought I would throw this in to the mix. That is how I am dealing with having v not having rads. I was really nervous about my heart and lungs being involved!

Here is the link -  http://medicine.yale.edu/cancer/research/trials/active/NCT01646346-2.trial#

"In fact, reputable studies have shown a slight increase in the overall or all cause death rate [called overall survival rate] for women treated with radiation versus those who did not have it."

I know that many of the older studies showed no difference in overall survival rates, largely because any BC survival benefit from rads was wiped out over the long term by mortality increases that were caused by the rads themselves. However I haven't run across any studies that show that the overall mortality rate is actually higher among those who've had rads. What I have run across are more recent studies that are starting to show a significant overall survival benefit among those who have rads, thanks in large part to changes in procedures which have reduced the long-term harms from the radiation therapy.  This article is almost 10 years old so it doesn't include all of the latest studies but it explains the issue quite well:  Postoperative Radiotherapy for Breast Cancer: Growing Evidence for an Impact on Survival

So do you have links to any of these reputable studies that you mention?  I'd be very interested to see them.