Some Older Women W/ Early-Stage HR+ May Be Able to Skip Rads

I am 76 and recently had a lumpectomy. This week i consulted with a RO about RT and was told it was not recommended for me due to my age and low risk/ Luminal A status. She sited a 2020 recent well respected study. This is a NCI designated comprehensive cancer institute. I was relieved.

I will see a MO today and i want to know what my risks are if I refuse HT. The side effects are some of the same I already have due to old age and I do not want to duplicate them. I am active with no other health risks, and my quality of life is very important to me at this point in my life. My husband has A fib and is short o breath due to reduced lung function. These next 5 years will be our last opportunity to travel together, visiting family and on vacations. I will have to remain active to facilitate our travel. I want to be monitored with 6 month mammograms, continue healthy active lifestyle at least while my husband is still able to and have a moderately active life..

Have any of you with low risk BC have experience with no treatment after surgery?

I can't imagine recommending any woman to skip hormonal therapy without trying it. For some, it really is like a sugar pill. There are three options for post menopausal women, and one of them might work for you with no perceptible side effects at all.

I think it is worth having a more broad ranging conversation with your MO and maybe pulling your RO back in to do a global assessment of your risks to help you make your decision. One older (mid 80s) buddy I made during radiation refused hormonal therapy and doing just radiation was the compromise that her doctor was comfortable with. It did tire her out during and for a few months after, but she was able to mostly keep on with her life. I'm not sure your RO would have recommended skipping radiation if she knew you were planning/hoping to skip hormonal therapy as well.

Treatment can be harder for older people, but then so will treatment of a recurrence be. Even surgery gets harder on the body as one gets older. How much would it suck to have to deal with a (possibly worse) recurrence in the next five years, and have to go through the whole thing again?

Everyone has to make her own decision, but please go in with an open mind.

Radiation and hormonal treatment are not just for the long term, they are also protective in the early years that you are hoping to enjoy with your husband.

You might be one of the lucky women who really doesn't experience any negative quality of life impact from hormonal therapy at all. Unlike radiation, you can drop hormonal therapy at any time if it turns out that none of the drugs work for you.

Update: My MO listened to my reservations about the HR, mostly the side effects that are also what old age brings and my concerns about a double dose of fatigue, joint pains, weight gain, bone loss, risk of stroke, etc. Also discussed my quality of life for the next 5+ years. She was not concerned about a reoccurrence since I will have frequent mammograms but metastasis to bone or lung was the concern. i listened and agreed to trying HR.

Since AIs are contraindicated due to pending dental surgery and some osteopenia, I have been taking a reduced dose of Tamoxifen every other day for 6 weeks. The first 4 wks were the hardest with some side effects: a few hot flashes, irritability, weight gain and felt like I was operating at a 50% energy level so less activity. Now I still am operating at a lower activity level, have less will power when it comes to eating carbs and am slightly less irritable. yesterday I had another appt with the MO and I have agreed to take this same dose for another 3 months since my side effects seem to be getting better. Will go back to a WW plan to lose the weight I gained in the last 15 months after maintaining my 35 lbs loss 3 years ago for 2 years. Hope to curb the irritability as well. I do not know if I will ever agree to a stronger dose of this HR or if I will continue this low dose HR for 5 years. My MO thinks getting me to take the equivalent of 5 mg of Tamo/day is better than taking none.

I have skipped over to this post since I wanted to find topics about how older women are doing with or without treatment. There was another forum with wonderful people but it seemed to get off the track of the original intention and has become more of a social outlet. So here I am on this one. I will be 69 this year and I truly believe that although we are maybe more fortunate to have lived lives without BC for a long time, the treatments are more harsh and ill-tolerated in late 60's to 70's. Of the unfortunate BC friends that I know in their 40's and 50's who were diagnosed they seem to breeze through treatments much better.

Mind you, 6 months ago I considered myself a healthy 68 yo still working in an active job. Started Kadcyla chemo last January and by March was very ill with early lung pneumonitis and stopped that. Only did 4 rounds. Took a break to get well and then now just started L breast radiation. Two weeks in to this and need 2 more weeks. Already seeing tiredness. I had early stage BC and a good path except for the HER2+ which meant chemo and herceptin. I will then need 4 more Herceptin only infusions after radiation then consider the AI. My choice to do everything sequentially and not concurrently. I truly think that pushing dual treatments all at once is a set up for problems in "older" women. My oncologists are ok with what I am doing. Hopefully this forum will keep to how us "older" gals manage treatments.