Radiation necessary in an early stage cancer

Hi Bliz!

I know you've been diagnosed w/ early stage cancer, but am not clear on whether you've had surgery yet or not.

Can you tell us a little more about you, your biopsies, surgeries and pathology reports?

For example, for some early stage cancers, they will tell you that the survival rate is the same for the following two alternatives:

1. Mastectomy (w/ no radiation)

2. Lumpectomy with radiation

So if you had (or are going to have) a lumpectomy (and since you asked about Mammosite therapy in another thread I think you might have had, or be planning, a lumpectomy), that might be why your doctor is telling you that the "standard of care" is that you also have radiation (if that's what he's telling you).

But if you give us more details about your situation, we may be able to be more helpful...

LisaAlissa

Whether radiation is really "necessary" or not depends on a number of different factors which include all the specifics about your tumors pathology and ALSO how comfortable or uncomfortable you PERSONALLY are in assuming a certain degree of potential risk in not having post-lumpectomy radiation.

Every single trial ever done that has addressed the issue of recurrence after lumpectomy has always shown that the vast majority of patients never suffer a recurrence when treated with lumpectomy alone. However, when there are recurrences, they occur less frequently in those who have undergone post-lumpectomy radiation as compared to those who have not.

Numerous smaller studies have been identifying a subset of women with invasive cancer who have a recurrence rate as low as 6% without radiation. These women are generally identified as being older (usually >60), with small (<1.0) low grade tumors, no lymphatic or vascular invasion and wide clear surgical margins. So if you happen to fall into this categorization and you're comfortable with a 6% recurrence rate in foregoing radiation, then the answer to your question would be no, it's probably not necessary since radiation wouldn't likely benefit you very much. If on the other hand, you have a high grade tumor with other deprimental prognostic factors, the benefit from recieving radiation might be considerable higher.

I had a low small, low grade tumor diagnosed in 2/2004 that fit that criteria for low recurrence without radiation with one exception...I was just a week past my 49th B-day at the time so was definately too young for the age criteria to fit. However, I weighed all factors and considerations and made the decision that it was close enough to suit me and so declined radiation. I was willing to place my bets on being in the majority that wouldn't reoccur primarily because I really don't fear a recurrence of that same low grade cancer. If my cancer had been aggressive, I might feel very differently. But for the tumor I had, I'm very comfortable assuming the risk that it might reoccur again...and as crazy as this may sound to some of you reading this, I fear the potential consequences
of radiation far more than that low grade cancer I once had.

Bliz, I can totally feel your concern. I was in a similar situation but age 60 at diagnosis. My surgeon figured I might be able to do without radiation but sent me to my oncologist and I went through 7 weeks of rad therapy and am a month out from the process. Mine was on the left side and I had some heart involvement. My radiologist drew me a picture of its involvement. I am not worried about that as much as my other breast down the line. My radiated breast feels soft, strong, a little smaller and healed. Both will get the Arimidex treatment. But your concern and questions are well founded. I guess I finally came to an acceptance that in the day and age in which I live I am not bigger than the medical knowledge being practiced at this point.

I have been looking through all the posts on this subject.  I am 54 - had lumpectomy with <0.02 cm DCIS & am torn about what to do.  I am ER & PR- but I feel the long term effects of 33 rad treatments may be too much (it's my left breast).  I decided against the mammosite, but wish now I could have it - I'm now considering the 3D conformal.  Rad. oncologist is saying because of my young age & being er & Pr - to have full breast.

Girls-

I just finished rads at NYU Cancer Center two weeks ago - I went o NYU for three reasons - one was the rads trial I entered was a three week, 15 treatment program that gave me the same amount of rads as the 33 treatments (boosts included) and I also was early stage no nodes, etc. and I was able to be treated on a prone table - lying face down with my breast hanging down and radiated from below on each side - so that only the breast was radiated and all other healthy skin and organs were spared rads - this type of table is in use at large cancer centers around the country - I am large breasted and my skin was only pink after 15 treatments - I did develop one sore spot under my breast for about a week after rads and used my cream as well as a panty liner or sanitary pad with my sports bra - the pad wicked away moisture and padded the sore spot so I could play golf!

I too was very worried about rads, but the program and prone board were just what I needed to complete my treatment plan - oh and the third reason to NYU was the incredible staff and equipment - I live in the DC area and there is nothing like the NYU Cancer Center here - hope this helps some of my sisters out there -

SharonW

Bliz,

I just finished radiation treatment and I was dx with early stages of cancer. After a lumpectomy and now radiation I feel I am doing all I can to prevent recurrance.  DCIS is many times a precurser to additional cancers.

Here is a great link to read more about the studies done and the probability of recurrance.   http://theoncologist.alphamedpress.org/cgi/reprint/12/11/1276

It's each person's decision but I feel I must do all I can to prevent recurrance.

Good luck!

Beth 

Radiation is total overkill. For most breast cancers.



In 2006, I had a 2cm IDC, Hormone +, HER-. Excised, with WIDE margins, with lumpectomy. I elected, no radiation. And with my oncologist visit, she said, "you didn't have radiation? Then, the Tamoxifen, is useless."



So, I didn't have that, either. Although, I wouldn't have taken it, anyway.



I've already had, another cancer. Leiomyosarcoma. That was successfully, surgically, cut out. With wide margins.



But with that cancer, there was no "radiation" ever suggested, to me. Because that cancer is so rare, there's no $$$ to be made, on it.



Yet, there's Big $$$Money, to be made, with needless breast radiation.



It's sad, to me, that so many women are so frightened, into needless "radiation treatments."



Like breast cancer, is the only thing you can ever die from.



Which is just NOT the case.



And with the "treatments," so many women develop so many OTHER problems.



?



It's insane.



I will NEVER do breast radiation.

Hi,

This is where I am with my thinking about my treatment.  I felt very alone until I found this conversation.  I knew there must be women who had decided against radiation but had moved on with their lives but I missed their voices. 

Hello -

Two weeks ago I had a lumpectomy for DCIS. Margins clear. Do I really need radiation? Would love to here more from people who have decided against radiation and how their life is going post that decision.

Many thanks.

Well sisters, all we are going on is the statistics.  I had a 7mm tumor, very small, with a lumpectomy.  I was a Triple Negative, too.

Now, they do chemo for my situation, back in 1998, they just did the rads.  I had no problems with this and am 9 & 1/2 years post treatment with just a rib issue, no heart or lung problems, even though the cancer was on my left breast.

It is hard to decide, but the statistics are over-whelming in favor of radiation.  AND as far as money to be made on this, a lot of the studies are done overseas,, Denmark had a huge one, England, etc., where it benefits no one monetarily if you have rads or not.

These scientists and the medical profession are on salary and could not give a fig what it costs to do radiation, give that a thought too.

So be careful.

Here in San Diego, where I am, I am on an HMO, where they make more money when they DON'T do things, I had a battle royal getting a colonoscopy, had to change doctors.  I have not had ONE single test for follow-up other than mammo's, so to assume this is just a money maker, at least for me and most of Europe is wrong.

Hugs, Shirlann

I too am going round and round about whether to get radiation after a mast.  I'm just finishing up my 6xTAC chemo, and can't put off thinking about this decision any longer.  I've been doing some research, and asked my chemo onc team, and everything seemed to point to no rads necessary in my case.

I had my first consult with a radiation oncologist Monday.  To my surprise, he recommended radiation, doing the chest wall and node Levels III and IV.  (There's probably some abbreviation on this site for the different levels of rads, but I haven't been on this thread enough yet to pick them up sorry!) I already had a full Level I/II AND with my bilat mast.

I've been pouring over medical journals, and am finding that radiation oncologist are moving away from the old 1-3 positive nodes v. 4 positive nodes division as to whether to do rads.  They now say that radiation after mast should be considered for all node positive patients, no matter the number.  But then they also seem to say that other factors, such as tumor location and size, percentage of positive nodes, age, ER status, and lymphovascular space invasion should all go into making the determination as to whether rads can be reasonably recommended in a particular case. 

The rad onc didn't mention any of these factors as they apply to my case, and seemed to hinge the whole thing on the one positive node.  When I asked him why, he just kept citing those oft-quoted Danish and Canadian studies without really providing any specifics as to how they applied to my case.  I really tried to pin him down (my husband who was there later said that I cross-examined him!) and he never could give me any concrete reason why rads, especially rads to the remaining node levels, was appropriate other than to keep saying those studies showed that women with one node benefitted from rads.  It was as if he'd gotten no farther in reviewing my chart than to see the one positive node, and just went on that without fully evaluating my particular case.

What's scary is that this was at a major breast center - I've been thrilled with my surgical care there, so was very disappointed in the attitude of this particular rad onc and his apparent failure to fully review my case before making his recommendation.  It's the complete opposite of what I've come to expect.  

Needless to say I will be getting a second opinion.   

As someone said, we're just ordinary people - isn't it crazy that we have to read through medical journals to make our decisions? 

Congratulation on your all clear mammo! that is brilliant.

I agree with you - knowledge is power. What is more, if it goes into ME I want to know what, why, how it is made, what side effects, and why the side effects. I want to be able to ask questions and to suggest treatments - and it this situation, the doctor's experience can help me sorting out and choosing appropriately. for me, being ill does not mean giving up ownership of my body, but rather seeking advice on how to make it better.

Doctors are doctors... not magicians. And in the best of situations, there is still a lot of unknown.