Without hormone therapy, will rads increase recurrence risk?

Alital82 · March 2018

Hi,

I am new. I am a premenopausal woman, age 35, operated with ductal carcinoma with small IDC component. Highly ER+. I do NOT want to do hormonal therapy, although well aware that it could be effective. My onco decided to put me on AIs (+Decapeptyl). I want to work on my health and overhaul my life. However, this decision behind me, now the rads I took for granted are coming up in a week and I am beginning to wonder whether the "natural route" only actually works if you go 100% that way. Because, through extensive research, I have learned that (the UCLA study) radiation therapy has been shown to multiply cancer tumor stem cells remaining in the breast and lower the immune system. Obviously my onc did not say that and says I have to get the works. There are studies that say that radiation reduces recurrence risk (which are usually based on 5 yrs). I just want to get better (not get sick either through cancer or medicines that force my body). Of those of you out there that did not start or interrupted hormone therapy early, who did NO hormone therapy BUT rads and who did NO hormone therapy and NO rads and how did it go for you? I am really going on a hunch after reading so many things...and I really believe everyone's body is different, but since there are no studies I'd like to know what your gut feeling was after the fact.

Thanks

Kay7751 · March 2018

I was given a pass on radiation because of my age. All of the synthetic hormones given to women in the past were bad for us. I'm taking bioidentical hormones. I've always known that hormones werean issue for me. I am removing as many toxins from my life as possible. No meds that increase aromatase. Feeling great!

KBeee · March 2018

Radiation affects the risk of local recurrence, while hormone therapy impacts distant metastasis risk. It will come down to how much of arisk you are willing to take. Everyone had their own risk tolerance.

Kay7751 · April 2018

so the Tamoxifen doesn’t always work?

Kay7751 · April 2018

so the Tamoxifen doesn't always work? How do you trust synthetic hormone therapy?

pupmom · April 2018

If you are premenopausal, why didn't your MO put you on Tamoxifen? Also, ductal carcinoma is the same thing as IDC, as far as I know. If you have a lumpectomy, radiation is standard of treatment. Most of the time, if you have a mastectomy, you don't need radiation. A lot of your post doesn't make sense. I think you need a more in depth talk with your doctor.

Lula73 · April 2018

Hundreds of not thousands of studies have shown rads to be beneficial in eliminating local tumors and any remaining cancer cells in the immediate area. I read the study you referenced and it is very important to note the head researcher's comments:

Even if you say well this regeneration happens so i don't want rads, without rads you will likely have recurrence faster and likely die earlier too than if you'd done them. If the cancer is not in the lymph nodes, a mastectomy would likely preclude you from needing rads and you could skip them altogether with well documented clincal evidence to back up that decision.

The hormone therapy that they use for ER+ BC is really not the hormone therapy that is most talked about (ie to help relieve symptoms of menopause) and like was referenced by Kay above. Hormone therapy for BC is really ANTI-hormone therapy. ER+ means the cancer cells are fueled by estrogen. estrogen is their “food". Anti-hormone therapy basically starves those cells by either blocking the estrogen action in your body (tamoxifen) or blocking the production of estrogen from the aromatization process (how estrogen is produced in post menopausal women). Your doctor is advising cutting edge therapies for you that have well studied and documented efficacy in reducing risk of local recurrence, mets and increasing survival as demonstrated by choosing the decapeptyl + AI combination:

It's great to want to overhaul your life and make changes for a healthier life. Sounds like the diagnosis was a wake up call for you. All of that will serve you well during treatment and after. However, you are dealing with the here and now. There are no randomized, controlled clinical trials that definitively show equivalent efficacy to standard treatment by “eating healthier and exercising.” The odds are in the favor of standard treatment. If you choose to go the alternative route, that is your right and your own personal decision. But I will point out that the odds of any of us developing BC in our lifetime is 1 out of 12. We are already on the wrong side of the stats...are you willing to throw well studied/documented data out the window that gives you the best odds of survival and/or disease free survival? Only you can answer that question.

AngelsGal57 · April 2018

I am a Her2 breast cancer patient who finished chemo in AUG 2017 and will have my final 2 Herceptin infusions in May. I am 4 1/2 months out from my last rad treatment. I did radiation with no outward side effects but do have numbness of the rt breast tissue and soreness where the scar tissue is from the partial mastectomy. I did all of the prescribed treatments EXCEPT pharmaceutical hormone blockers and instead am on a herbal Pueraria Mirifica a plant derived hormone blocker.

The only issues I am having with the Pueraria Mirifica are the typical PMS type symptoms such as hot flashes 2 - 3 times a day and wacky emotions. The down side is that rather than lasting a week during mensturation (When I used to have periods 6 years ago) It now lasts EVERY DAY. Some days are worse that others but because I know what is the cause it is manageable.

I know that not everyone is on the band wagon regarding natural treatments yet I have done my homework and with a strong daily supplement routine am pretty much back to work and a normal life. I have a terrific wellness coach at the Cancer Treatment Center who is assisting me with getting my life back and it makes a huge difference. I have been walking 5 days a week for the last month and never thought that would happen. It is baby steps that are really making a difference.

Hope this helps you navigate your treatment plans.

Angelsgal57

Polly413 · April 2018

Lula, could you post a reference to support your statement that foregoing radiation means quicker recurrence and "likely die earlier too"? I do not interpret the researcher's conclusion in the article you posted the same way you do. I think what the statement says is that the study shows that radiation has an adverse effect that was unknown previously: that is that radiation can stimulate cancer stem cells and increase the risk of aggressive cancer and that this discovery is important because now they can try to find ways to block this effect which is harmful to patients but in the meantime they do not want to take the responsibility of advising patients to forego radiation against MO's advice. Eighteen years my MO at a large teaching hospital in Houston advised me that radiation (which they still wanted me to take) would decrease the risk of local reoccurrence but if the cancer came back anyway it would be more aggressive and likely to result in death. At that time they thought it was because radiation made mammograms more difficult to read and thus later cancers would be more advanced before they were found. Today they seem to be saying its because of the stimulation of cancer stem cells. So I am interested in your comments. Polly

Lula73 · April 2018

Polly-here’s one of many:

http://www.cancernetwork.com/oncology-journal/lumpectomy-and-without-radiation-early-stage-breast-cancer-and-dcis

Does anyone really think (vs wanting to think) all these docs and research centers are recommending rads if they do not make a significant difference in recurrence/mets/survival? The whole thing with lumpectomy + rads is to get equal efficacy to mastectomy when it comes to overall survival. Lumpectomy + rads still has higher recurrence rate vs mastectomy without rads given same stage, grade and hormone status. If you opt for no rads, get recurrence and/or mets it follows that survival is impacted. Not saying that everyone who skips rads will get recurrence or all that choose to do rads won’t get recurrence. It all comes down to odds: rads decrease risk of recurrence, mets and/or low survival rate to a statistically significant degree even with the stem cell regeneration issue brought to light in that study at play. Anytime cancer recurs regardless of rads it is harder to put back in remission period.

We have known for a decades that rads can be detrimental to health and/or survival. However they have also figured out that rads can be beneficial in a number of ways: imaging and destroying cancer cells are two of them. The keys to successful rad therapy for cancer are: the right type of rads matched to specific cancer, right amount of rads at each session given in the right areas based on stage and type of cancer and the right number of sessions again based on stage and type of cancer.

The last 4 paragraphs of that study (which is in the 1st photo in my post above) are the most important concerning what the conclusions of the study were and it’s potential moving forward. Note that he did not say don’t do rads... he says continue rads if your Oncologist recommends it. Note he does not say that this study will lead to new treatment paradigms that dictate removing of rads from the current paradigm...rather he says this discovery can lead to being able to stop it (‘it’ being cancer including those transformations) and make the therapy (rads) even more powerful and carries enormous potential to make radiation even better. It’s very straight forward language that he uses.

Deciding not do rads to treat the cancer that’s here & threatening your life right now based solely on that study for something that may or may not happen is like not eating when you’re literally starving because the food you’re being offered isn’t organic or non-GMO and may carry a risk of health issues years down the road. First we have to take care of the starvation issue and prevent death before we can even start to think about the what-ifs of eating non-organic/GMO or we will never make it to see if the what-ifs ever come to fruition. (This example takes into account that organic and/or non-GMO food is not available/an option). Or not taking Tylenol or Advil/aspirin for headache/fever/etc because Tylenol may cause you to have liver issues down the road and ibuprofen/aspirin may cause you to develop an stomach ulcer down the road.

KBeee · April 2018

Kay, you had asked if Tamoxifen always works. Nothing always works. It decreases risk of metastasis, but nothing completely eliminates the risk. Everyone is different in how much risk they are willing to tolerate, and also what health conditions they have that may make medications a better or worse fir for them. There is never a right answer, and no one has a crystal ball. Ultimately, we all just have to make the decision that seems best for us at the time.

Lula73 · April 2018

Kay- along with what KBee stated, tamoxifen and AIs don't always work. You may ask why that is. Sometimes the cancer is just more aggressive and tamoxifen/AIs may onlybe able to slow it down. Additionally, not all BCs are Strongly ER+. That means that the cancer cells are fueled by more than just estrogen. That's also why those women whose BC is highly ER+ have better outcomes. Does it mean you shouldn't take tamoxifen or an AI if your ER number was lower? No, it does not. Any suppression of Estrogen in an ER + BC treatment is better than none to give the best shot at keeping recurrence/mets at bay and prolong survival. However, if the BC is ER-, tamoxifen and/or AI is not beneficial at all and therefore not prescribed.

Without hormone therapy, will rads increase recurrence risk?

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