Confused and worried

Venus,

Treatment for the elderly often differs from treatment given to younger women. My mother was diagnosed at 80 and her only treatment was a lumpectomy plus a re-excision surgery (a second smaller lumpectomy) to increase the size of the surgical margins. Her doctors discussed both radiation and anti-hormone therapy, but with a favorable diagnosis, they were completely on board when she opted to pass on both treatments. She's 96 now - no recurrence or new breast problems.

What is your mother's diagnosis? That's critical to the treatment decision.

My mother had breast cancer at age 85 and had six weeks of radiation with no problems. I have extremely fair skin that sunburns easily and I had no problem with six weeks of radiation either. I got a little bit of pink on my collarbone, and I think if there are no micromets, that area isn't as heavily zapped.

Alternative treatments to radiation? No. It's not a DIY project. A patient can refuse radiation, but there isn't a lay substitute. Is your mother in good shape for her age mentally and physically, apart from this diagnosis? Then she needs to be the one to decide how she wants to be treated.

Venus, IDC grade 3 is part of the diagnosis but that's too generalized / high level. To determine the treatment plan and the amount of benefit from rads and anti-hormone therapy, other important factors are:

- the size and focality of the tumor (one area of cancer or more than one, how widely spread out?)

- the size of the surgical margins (was the cancer within the breast tissue that was removed surrounded by a large area of non-cancerous tissue, or did the cancer come right up to the edge of the removed tissue?)

- whether there is nodal involvement

- the ER and PR status (and percent strength of ER and PR, if ER+ and PR+)

- whether the cancer is HER2+ (I'm assuming not, since it appears that chemo is not being recommended)

- the Oncotype or Mammaprint score (usually but not always done for ER+ / HER2- cancers).

Does your mother have a copy of her biopsy and surgery pathology reports, and the imaging reports? This is important information that she needs to make her treatment decisions. Is your mother just dealing with a surgeon at this time, or has she seen a Medical Oncologist? Beyond surgery, the treatment plan should be managed by the MO. Surgeons operate; MOs do the rest.

My advice is to take a step back to review the situation. You've jumped to alternative treatments without understanding why the traditional treatments have been recommended and how much risk your mother faces and how much benefit your mother will get from these traditional treatments. As other posters have pointed out, many older patients tolerate these treatments well. But before your mother makes any decision on whether or not to go ahead with either rads and/or anti-hormone therapy, and before you start thinking about alternative treatments, at the age of 87 what your mother really needs to understand is the amount of risk she faces - both local recurrence risk and metastatic recurrence risk - and the amount of risk reduction she will get from rads and anti-hormone therapy. Rads is given to reduce the risk of a localized (in the breast area) recurrence. If she had a large grade 3 tumor and narrow surgical margins, her risk might be very high, in which case the benefit of rads would be significant and to my understanding there are no alternative treatments that can address this. But if her tumor was small and the surgical margins were large, her risk might be quite small, in which case the benefit of rads would be even smaller. Anti-hormone therapy reduces the risk of both a localized recurrence and a distant/metastatic recurrence. Your mother's risk of a metastatic recurrence depends on many elements within the pathology - her MO is the doctor she should talk to about this. Here again, if her risk is relatively low, and considering that mets may take many years to develop, there might be little risk reduction benefit from taking anti-hormone therapy. But if based on the pathology of her cancer, her risk is very high, then the benefit will obviously be greater and your mother might decide to try anti-hormone therapy (she can always try them to see how well she tolerates these meds).

Is your mother making her own decisions, or has she asked for input from you (or the family in general) or are you actively involved with her care (attending appointments with her)?

There are shorter radiation protocols - I had about 18 or 19 and it was very easy--I was 63 when I had rads. I'd like to also suggest that you put aside the alternative treatment information for now and hyper-focus on 'why the traditional treatments have been recommended and how much risk your mother faces and how much benefit your mother will get from these traditional treatments (per Beesie).

Venus,

I don't know if you are still reading here. I hope you are. And I'm sorry that you are upset by the responses you received.

In re-reading your first post, you did not state that your mother is confused and worried; you said that the family is, and you are. You stated your concerns - no one reading your post would have any idea if they are your mother's concerns too. So it is fair to ask, and speaking for myself, I think I asked respectfully. I mentioned in any earlier post that my mother was diagnosed when she was 80. My mother is someone who would be inclined to take a doctor's advice and not ask questions. But she knows that it's better to ask the questions and is happy to have others do it for her. So when she was diagnosed, my father accompanied her to all her appointments, he informed me about what they were told, I did the digging around the internet and the 3 three of us discussed everything. After that, my mother made the decisions. So I was not passing judgement on your questions but merely wanted to understand your role.

If you are still reading, I'd suggest you re-read my posts. I was not arguing against alternative treatments. What I was suggesting is that you first take a step back to determine how necessary the traditional treatments actually are. At 87, the average life expectancy for a woman is 6 years. With luck your mother might have 10 or 12 years. Most breast cancer treatments aim for long-term survival; based on the average patient, that's more like 20-30 years. This is why an understanding of the pathology is so important. For example, if your mother has a diagnosis that is prone to late recurrence, perhaps no treatment beyond surgery is necessary - at your mother's age, treatment should aim to reduce her risk of serious illness for the next 5-8 years, not 20-30 years. This is why treatment protocols are often different for elderly patients. This is what your mother (or you, if you are accompanying her to appointments) needs to speak to her MO about.

It may be that your mother has a very aggressive cancer that puts her at immediate risk. But if not, if more if her risk is longer-term, it would not be unreasonable to skip the traditional treatments. And in that case, if the traditional treatments can be skipped without significant short-term risk, this also means that alternative treatments aren't necessary.

You've jumped to a lot of conclusions without having most of the facts. Suggesting that you step back and get the facts isn't being unsupportive - it's being practical and it will lead to better decisions on treatment, whether in the end your mother chooses traditional treatments, alternative treatments or no additional treatment.

Good luck to your mother! Personally I'd be very interested to hear more about her diagnosis, what the MO says and what she decides to do.