Totally Confused ...

Hi there! Welcome to BCO!!

Not sure what you mean by tamidex....do you mean either tamoxifen or arimidex? They are both types of hormone therapy for breast cancer.

Getting radiation will not remove your need for hormone therapy. Radiation kills tumor cells that could have been leftover. Hormone therapy targets hormone positive cancer cells that may have escaped the breast area, as they can easily do even if the lymph nodes are clear.

Usually radiation is done after lumpectomy, followed by hormone therapy. Did the radiation oncologist say why you didn't have to have it?

I agree with the other posters that the two questions are mostly separate, although only you can make the holistic calculation for the level of risk you feel comfortable with.

Hormonal therapy (tamoxifen or arimidex, not sure which you are being recommended) directly helps prevents distant metastasis by suppressing cancer that might have already escaped the breast (and also helps with local recurrence for the same reason). Radiation therapy directly helps reduce local occurrence by destroying any cancer cells that might be left in the breast - and indirectly helps reduce metastatic recurrence because local recurrences can lead to metastatic recurrence before being detected even in women being actively followed for risk.

Radiation done well is usually very well tolerated. I met a woman getting radiation with me who was in her late 80s and doing fine. The motivation for skipping radiation is older patients is because it is less likely that a local recurrence will occur and/or have time to metastasize within their natural life time anyway. But for someone who hopes to have another 10-15 years, it can still be a real benefit. Another concern is that the older we get, the harder that surgery tends to be on a body. So even if a local recurrence was caught early, the recommended surgery might pose more quality of life issues/risk than the radiation now. Of course, the added wrinkle right now is increased exposure/risk of Covid19 by going regularly for radiation.

Hormonal therapy is like sugar pills for some women, and some women try every form of it and can't find one that is compatible with quality of life. But the nice thing is that they can be tried and quit if you don't like the side effects.

Is there a social worker or nurse coordinator affiliated with your center that could help you talk through your specific case and the doctors' recs and the research, so you that you can feel you're making an informed decision?

On the one hand, this is all very stressful with so many unknowns and it's impossible to ever be 100% sure you've made the best possible decision. On the other hand, the good news is that actually for most of us, it doesn't really matter what we do - there's a good chance we'll be fine no matter what, and also it's never possible to be 100% sure you've made the wrong decision either, since bad outcomes can happen even with all the most hyper cautious forms of prevention.

Good luck!

I had a small one, 45 mm with many microcalcifications. I had bilateral mastectomies. Margin wasn't clear. So I had radiation. My medical oncologist said that an aromatase inhibitor would decrease my chances of recurrence only by 1 %. I had radiation. Just know that there are side effects with every treatment, still have pain and hyperpigmentation of my breast. I decided that I would forego AI's. I took HRT before diagnosis. There was a lot of misery for me being off HRT. Trade offs are not great. BTW was 69 when I was diagnosed. I am hoping I can live with them.

AliceBastable...side effects are listed in chronological order of frequency. Of course anyone can experience any side effect or not but its a good way to help in the decision to take or not. Good luck to all.