Interesting study on Radiation treatment

Sometimes data findings don't go out of date, and sometimes they do.

If a study presents 5 year results, and then the study continues and the 10 year results lead to a different summary conclusion, this means that the 5 year results have in fact gone out of date. Or if another more detailed and/or longer study comes out that refutes an earlier study, that too might make the earlier findings obsolete.

As Selena indicated, this is exactly what happened with the Tamoxifen studies. A 10 year study suggested that 10 years of Tamoxifen was no better than 5 years of Tamoxifen. So given the side effects of the drug, treatment standards recommended 5 years of Tamoxifen only. But then last year, a longer study (I can't remember if it was 15 years or 20 years) came out that showed that longer term, 10 years of Tamoxifen actually was significantly better than 5 years of Tamoxifen. And now the treatment standards have changed and that earlier study is not longer used.

Of course many older studies remain valid. Some older studies provide better information that newer studies, if the older study ran longer or had more participants or measured more variables. But each situation must be assessed for it's own merits. If a newer study refutes an earlier study and if the newer study is statistically more reliable, then that certainly puts into question the older results. And if a study continues and the long term results differ from the interim the results, the interim results no longer have significance.

mgis - you wrote: "My radiology oncologist told me that it's my choice to either get radiation or not. And, that getting it would reduce the chance of reoccurrence from 15% to 5%. I'm still conflicted but that's a big % in my opinion." Those are exactly the same percentages that I was given when I was wrestling with this question 6 years ago. My RO went to on to say that those stats meant that 90% of women in my position were radiated for no reason. 85% will not recur, whether or not they do rads. 5% will recur, whether or not they do rads. That leaves 10% of women who get a reduction in recurrence. But in my case, the studies at the time indicated there was no survival benefit with rads for me whatsoever - just a reduction in recurrence. With survival off the table, then it became a QOL issue for me. Was that 10% benefit worth the possible risks? In the end I declined rads, but that's the decision that was right for me. Another woman in my same position might make the decision to go through with rads and that would be right for her. My RO said she would be comfortable with my decision, no matter which way I went. It's a tough decision for us gals in that "grey area".

Obviously new and ongoing studies will refine these stats, and studies may end up showing some long term survival benefits. But we can only make decisions based on the information that is available to us at the time. The decision whether or not to do rads was the hardest decision I had to make during my active treatment. I wish the best for anyone who has to wrestle with this difficult decision.

Thanks, Natsfan - Good clear explanation. I am among those who stood very little likelihood of benefitting from rads treatment, yet every health care provider I encountered urged me to do rads "because it is "so protective against recurrence" (and to some degree, any mets that then originate from a local recurrence). I did IMRT rads (which caused radiation necrosis for me as well), and at 11 years out as a HER2 positive who never received trastuzumab, I remain NED. But this study provides very new information about conversion by rads of other cancer cells into breast cancer stem cells, so the maximum length of time involved in the conversion to stem cells may not yet be adequately defined. And that leaves "present recommendations" in effect, whether or not there may be long-term stem cell creation for those people whose benefit was next to nil like me..

A.A.

anyone see the news report about the us military ship which went on a resue mission after the japanese tsunami, went unknowingly through a radiation plume from the wrecked nuclear plume & now 2+ years later are having extreme health problems

abigail, are you really trying to say exposure to fallout radiation after a nuclear meltdown is similar in health consequences to focused radiation treatment? Because that is ridiculous.

Alaska, the thing is, to me anyway, that the stem cell discovery is certainly concerning and an unhappy one. However, if it is the case, it would have been the case all along, including in the studies showing clear benefit from radiation treatment.

Again, I do think there are cases where it is completely reasonable on a risk/benefit analysis to turn down rads. But equally there are cases, mine for example, where it would be unwise to turn it down.

Alaska, I hear you. Also in an ideal world we would all have dedicated, sensitive doctors who would engage in a reasoned dialogue. Sadly many of them do not.

Another problem I see with a lot of the studies, not just on radiation, is that the field has moved fairly quickly in the last 20 years. Even in studies where they did follow patients for 20 years, the treatment I got 2 years ago is likely quite different from the treatment the patients in the study would have gotten.

lets not forget that heart disease in the leading cause of death in NA or the western world.Its very difficult to exclude confounding factors such as diabetes, obesity, high cholestrol, bad diet and genetics as the cause of any cardiac event or condition in any study for rads . I also dont think all docs are bias, my RO and I sat down, looked at my individual cancer situation, looked at the risks and looked at the latest research, she was not bias what so ever and i never felt any pressure to choose one way or the other.

Rdrunner... my oncologists were the same.  They were very up-to-date with the latest results, they were both quite willing to sit down and go over the studies and the questions I had, they were both very blunt about the risk vs. benefit part of my treatment decisions based on my personal health profile.  After reading some of the stories some of the posters at BCO have to tell about how they've been treated, sometimes, by their oncologists, I shudder.  Open dialog is, always, the best.

The issue I've taken with the original post is that, while the new findings are concerning; like momine pointed out, they must have always been there.  They couldnt' have just, suddenly, sprung to life and they must be kept in context.  If they are, then the previous studies showing a clear local recurrence benefit, and the more recent studies indicating that there is a distant recurrence benefit, as well; are all still valid even given the new stem-cell findings.  If there wasn't a benefit, then the research would reflect that from the very beginning.  Which means that, if this study is taken out-of-context and misinterpreted, it could create rampant fear among newly-diagnosed women about discussing the benefits/risks of radiation with their treatment team, leading them to refuse a treatment that has been tried- and proven to work based on that fear.   And, they would be encouraged in that fear by others.  Hence the term "fear mongering".

I've never, ever claimed that radiation didn't have risks.  It does.  And these risks are different for every woman and her particular cancer/health profile.  What I object to is blanket statements, like "radiation will leave you with permanent heart damage" or, now, "radiation will make your cancer more malignant" when this is simply NOT the case.  For some at-risk people this is something to be concerned about and they should be talking to their doctor about it, but for a majority of women, this is simply not true.

While the internet can be a very valuable resource, it can be dangerous, as well.  It's always best to discuss any fears and concerns with your treatment team and not rely on the University of Google or a discussion board to help you make treatment decisions.

some, not all of the smoke or co2 detectors give off nuclear radiation: not sensible

Abigail, you would rather burn up in a fire or die from carbon monoxide poisoning than be exposed to the miniscule amount of radiation from detectors? Oh, and btw, have you checked your foundation for radon? You are much more likely to receive a lethal amount of radiation from that source than smoke or CO2 detectors.

https://www.youtube.com/watch?v=X3mTt1MQEng&list=PL4A07007BE3E5978E

First, I am glad that there are those who feel they have reviewed what there is to know about radiation and are quite comfortable with their own decisions about its use for their own cancers.

From my perspective, the data simply has not been adequately gathered to demonstrate accurately what the full range of risks actually are.

The discussions above seem to focus very narrowly upon solely the risks involved with initial radiation treatment following diagnosis. Given that the exposures to radiation include in addition whatever history of mammograms and CTs and other imaging procedurse so many patients are subjected to over time, I believe that the "guesstimates" about reasonable use of radiation would require the medical imaging facilities and providers to maintain a running count from the very first exposure all the way through the most recent one, to truly provide genuine scientific data to work with in making reasonable decisions about the risk/benefit of radiation exposures.

That, however, might mean that providers might have to make the effort that they have failed to make thus far, by providing not just their employees in radiation departments with "badges" that maintain counts for employee exposure over time, but actually giving equal consideration to total individual patient radiation exposure over time. There is no process at present requiring that an ongoing tally be kept for each patient for exposures. At present, it is not a requirement that any provider demonstrate any awareness and evaluation of such a record of exposures when recommending or prescribing additional radiation. Without that consistent tracking and consideration, the evaluation of the effects of radiation treatment continue to not be based on accurate and complete measurement. 

I don't know anybody who gets routine dental x-rays twice a year, or chest x-rays once a year! Those shoe store x-rays have been banned for many, many decades.

I cracked an arm once, pelvis, knee went  kkskew on a fall once.  none diagnosed.  for the arm went up to the hospital & hid behind some construction & pissed every few minutes for a few hrs, it pains me now not at all.  I couldn't sit in meditation for a few months for the knee, then I could, & it still hurts when the weather is bad, likewise with the rear end.  had no exrays for any of it