Radiation necessary in an early stage cancer

Zeamer 3 wrote:

"But I do think it is irresponsible to express your opinion as an absolute assumption that EVERY woman is overtreated. This can have a profound effect on a woman who is clearly in need of this treatment but is petrified by a blanket statement such as that."

Zeamer, I have been on these boards for the last two years. As I said, I was diagnosed with my 2cm IDC cancer in May, 2006.

And I am unhappy to report to you that .... no one, is listening. To me. To not get the breast, radiation. Just read this board, or many others. A lot of women seem to embrace, the radiation. And just getting their breasts cut off. At the slightest, provocation.

Although, for my part?

The reason I walked out of my radiation SIM appt was because of post(s) from MarieKelley. Right on this board. The rational things that she said, two years, ago, And continues, to say. Today.

I'd "bought in" to the whole thing. And was just, going along. Until, the end. When I walked out. Because, unlike you, the risks never were worth, the benefits.

To you, they are.

You said you, "wanted my best shot of kicking cancer's butt at the beginning in hopes of never having to have treatment again."

And that, is what I don't get.

THAT is what I don't get. Of course, maybe that's because I've already had another cancer. A rare cancer. That could be a death sentence, in three weeks, with my next Chest/Abdomen/Pelvis CT.

I'm not going to kill myself, to save myself from Breast cancer, when I could die from this other cancer.

Or, die from anything, else.

We're all dying. In the end.

And women want a mastectomy for DCIS because they've been frightened into it, by the media. When women can live into, old age, with DCIS, and it's never a problem.

http://www.ahha.org/articles.asp?Id=95

This article is especially, interesting.

Zeamer3, I welcome your posts. Healthy, discussion.

We women, should be talking about this.

Because every woman should be able to make a decision, for her own body. And IMO, the medical profession, in this area, is forcing this radiation, on women. Needlessly.

That is my opinion, zeamer3. You have a different opinion.

ALL opinions, should be available, on this board.

Shirlann wrote:

Well Marie, what on earth makes you think the Denmark study was not done on REAL people?  Of course it was, the mice test was not even part of that study.Before you espouse questionable information that flys in the face of many, many tests and studies, maybe you better do your homework.You may be leading people in a wrong direction, and that would be criminal.Shirlann I'm still tryng to figure out exactly which study you're referring to? Have YOU actually read it? If so, please direct me to where I can find it because I can't seem to locate a large Netherlands study involving seeding issues in both rats and humans with the exception of the one below from 2005, which ONLY involved rats and then ONLY regarding SURGICAL implantation of tumor cells during colorectal surgery rather than breast biopsy. And nothing at all specifically out of Denmark either. My comment about studies on "real people" was made to convey the fact that any studies suggesting that needle track seeding doesn't occur are COMPLETELY CONTRARY to the existence of documented human cases in which recurrence from biopsy tract seeding HAS occurred. Any study, large or small, whether it's involving involving humans and/or rats or anything else, which categorically states tumor seeding absolutely does not occur must, for whatever reason, be incorrect in their conclusions. If that conclusion was correct, then there wouldn't be  human cases of tumor reoccurrence along a biopsy tract, would there?? Might this be the study you're refering to? Surg Oncol. 2005 Nov 1;92(2):124-9. Links Surgery promotes implantation of disseminated tumor cells, but does not increase growth of tumor cell clusters.Raa ST, Oosterling SJ, van der Kaaij NP, van den Tol MP, Beelen RH, Meijer S, van Eijck CH, van der Sijp JR, van Egmond M, Jeekel J. Department of General Surgery, ErasmusMC, Rotterdam, The Netherlands.INTRODUCTION: Local recurrence and peritoneal dissemination is common after intentionally curative resection of colorectal carcinoma. It is not yet clear which mechanisms stimulate post-operative intra-abdominal tumor development. Enhanced adhesion or growth of tumor cells and/or post-operative immuno suppression may influence tumor recurrence. AIMS OF THE STUDY: In the present study, we evaluated effects of local and remote surgery on intra-abdominal tumor development. MATERIALS AND METHODS: A standardized intra-abdominal trauma was inflicted by rubbing both uterus horns in laparotomy groups, while a dorsolateral thoracotomy was performed in thoracotomy groups (on day -1, 0, or +3). To induce tumor development rats were injected intra-peritoneally with the coloncarcinoma cell line CC531s on day 0 and evaluated after 21 days. RESULTS: Rats undergoing laparotomy and injection on day 0 showed significantly higher tumorload than control rats (195 +/- 20 vs. 47 +/- 29, P < 0.001). When a laparotomy was performed, the day before tumor inoculation even higher tumorload was seen (245 +/- 37 vs. 195 +/- 20, P < 0.01). Strikingly, performing a thoracotomy on the day before or on the same day as tumor inoculation resulted in enhanced tumorload compared to controls as well (135 +/- 84 vs. 47 +/- 29; P < 0.001 and 88 +/- 38 vs. 47 +/- 29; P < 0.02, respectively). Either laparotomy or thoracotomy 3 days after tumor cell inoculation did not affect growth of pre-existing tumor cell clusters. CONCLUSIONS: The (post) surgical intra-peritoneal microenvironment enhances successful implantation of spilled tumor cells, whereas growth of adhered tumor cell clusters is not affected. The inflammatory response as a result of remote surgery promotes successful tumor development as well. (c) 2005 Wiley-Liss, Inc.PMID: 16231370 [PubMed - indexed for MEDLINE]Then there's the following out of Austria from 2006. Perhaps it's this Austrian study (but no rats in this one) you're talking about ??  Please note that this study mentions  "several case reports"  and literature demonstrating seeding after needle biopsy in up to 50% of patients., so seeding  definately DOES occur and some people HAVE developed recurrence from it as evidenced from the reported cases of this occuring.  So how do you figure I'm disseminating questionable information when what I've said  about seeding concerns are indeed a documented fact??  Breast Cancer Res Treat. 2006 May;97(1):9-15. Links Preoperative core needle biopsy does not increase local recurrence rate in breast cancer patients.Fitzal F, Sporn EP, Draxler W, Mittlböck M, Taucher S, Rudas M, Riedl O, Helbich TH, Jakesz R, Gnant M. Department of Surgery, General Hospital, University Vienna, Waehringer Guertd 18-20, 1090 Vienna, Austria. florian.fitzal@meduniwien.acOBJECTIVE: Several case reports and clinical studies in the literature demonstrate needle track seeding after core needle biopsy in patients with breast cancer in up to 50% of cases. The impact of this observation on local recurrence and overall survival rate is, however, not fully investigated. PATIENTS AND DESIGN: We retrospectively analysed 719 patients after breast conserving surgery and postoperative radiotherapy for stage I and II breast cancer. We divided this group into patients with (189) and without (530) preoperative core needle biopsy. Demographic data, local recurrence and overall survival rate were compared between these two groups. RESULT: Preoperative core needle biopsy did not significantly influence the local free recurrence rate (median follow-up time of 78 and 71 months, respectively). The prognostic factors and the postoperative therapy did not differ significantly between the two groups. CONCLUSION: Preoperative core needle biopsy seems to have no detrimental impact on local recurrence and overall survival after breast conserving surgery and postoperative radiotherapy.PMID: 16502019 [PubMed - indexed for MEDLINE]Or maybe the following from Greece in 2008?  Though, no rats involved here either. Please note that although the following study says needle track seeding is of questionable clinical consequence, they further clarify this statement by adding '"when treatment guidelines are followed." Although this one says they found no tumor cells in the excised biopsy tracks other studies, one of which I provided in an earlier post, come to a very different conclusion.Michalopoulos NV, Zagouri F, Sergentanis TN, Pararas N, Koulocheri D, Nonni A, Filippakis GM, Chatzipantelis P, Bramis J, Zografos GC. Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Athens, Greece.BACKGROUND: A matter of substantial concern regarding all needle biopsy techniques is seeding along the biopsy needle tract. PURPOSE: To assess cell seeding along the needle tract of vacuum-assisted breast biopsy (VABB). MATERIAL AND METHODS: The study included 21 patients with ductal carcinoma in situ (DCIS) and 10 patients with invasive ductal carcinoma (IDC) diagnosed by VABB for nonpalpable mammographic lesions. VABB (11G, on a Fischer table) was performed, and the duration of the procedure was measured. After surgery, the whole needle tract was embedded in paraffin blocks, stained with hematoxylin-eosin, and examined by a pathologist. RESULTS: Cases with dissemination of cancer cells in the needle tract were not observed (one-sided 97.5% CI 0-10.0%). In 2/31 (6.5%) cases (95% CI 0.8-21.4%), benign epithelial cell displacement was observed, and the duration of VABB was significantly longer in these two cases (52.5+/-3.5 min vs. 42.0+/-4.4 min for cases without benign cell displacement; P = 0.018, Mann-Whitney-Wilcoxon test for independent samples). CONCLUSION: No displacement of malignant cells within the 11G needle tract was documented. Benign cell displacement was associated with longer VABB duration. The phenomenon of tumor cell dissemination along the needle tract is of questionable clinical significance when the treatment guidelines are followed.PMID: 18365811 [PubMed - indexed for MEDLINE]Shirlann,I really don't want to get into a boxing match with you about this because I'm sure you're a very nice person and mean well. However, it's very unfair of you to suggest that I'm passing around questionable information when the facts are otherwise. Seeding after biopsy and surgical procedures DOES EXIST involving many different kinds of cancers. There is absolutely no controversy about the fact that it does occur excepting the rare reports to the contrary such as the one from Greece above...which by the way, you'll note was only on 31 patients. The controversy that exists now and has existed for decades is NOT whether or not seeding occurs, but rather whether or not the seeding that does sometimes occurs leads to  local recurrence at a level that should be of any real concern. A Japanese abstract I posted a few days ago is just one example of a similar study which DID find tumor cell displacemet from biopsy needles in about 65% of their cases and overall  and the preponderance of medical literature involving both breast cancer as well as other types of cancers also documents the existence of biopsy tract seeding. Would you like to see some of those stuides on other cancers? Also, I really don't understand how you think my posting information like this is leading anyone "in the wrong direction". Although it's no secret that I'm against post lumpectomy radiation for small, well resected, low risk tumors, the information about needle track concerns actually SUPPORTS the rationale for doing radiation after all lumpectomies.So I'm really at a loss in understasnding what exactly it is about needle track seeding that you feel I shouldn't be telling people here??? What specifically is it that I say here that you don't want to hear? And more importantly, why does it seems to bother you so much?  

I am a little surprised after reading this thread.  It almost seemed I was on some anti-Western, alternative medicine site, the kind that accuse western medicine of propogating treatments solely for money, all the while ignoring their own pleas for monetary payment.

 Anyway, my wife is stage one, node negative, Oncodx score of eleven, lumpectomy with clear margins and her Oncologist recommended avoiding Chemo.  She did however strongly recommend radiation therapy and we are of course taking that advice.  I've searched the web high and low and have found very little research or medical information that does not recommend radiation as a way to even the odds for women who have chosen lumpectomy over masectomy.  It is a little shocking to see people here who are trying to convince others to avoid radiation.  Why would anyone choose to avoid radiation after a lumpectomy if it significantly reduces the odds of a recurrence for not much risk in the treatment itself, other than a little sunburn.  I just don't get it.  Are we to take the advice of some lone doctor who thinks radiation unnecessary?  I agree that medicine will advance with time, but all you can do is go with the best medical advice of the day, and I have to assume that all of the studies showing the benefits of radiation are not a fraud on the public to profit the medical community like some very ignorant posters on this thread suggested.

Worriedhub. I must post in defense of MarieKelley. First of all, since she is a survivor and you are not, you have no right to come down on her because your opionion is different from hers. Unless, you have had BC, you have no clue what it does to us, both physically and emotionally, so for you to say that she has no right to say what she says is maddening. If you will look at the title of this thread, you will see that it is about alternative therapies. I think most of us who post here, have no intention of trying to talk someone else into a different treatment. We are here to share our diverse experiences so that those looking for alternatives can get the support they want because their doctors are not doing so. Doctors are trained in a way that does not take into account things that cannot be measured easily. When they give stats, they do not include in those stats, what things might have effected the positive outcomes besides their drugs. Many women who are survivors have chosen to change their eating habits and exercise more, which has been proven to help to prevent recurrances. And for everywoman who may have died without further treatments, there is another who died with traditional medicine. So just because one does not follow the rules, does not mean that we are committing suicide. My aunt is a 20 year survivor who had her tumor removed and no other treatment.

Another thing that you will not understand is what we call "woman's intuition". The female body is more complicated that a man's and we are in tune to our hormonal swings in a way that men have no way of understanding. Many of us have been able to find our cancers early because we listened to that little voice in our head that told us to get to the doctor.

We here are not trying to say that traditional medicine is all wrong. I had great doctors who I have a lot of respect for, but they were not willing to help me find a different way. Because of fear of litigation, lack of education about nutrition, and their emphasis on taking drugs for every problem, they just are not there to help those of us who want alternatives. The women here are trying to support each other, and those of us who have chosen alternatives have learned a lot from each other.

Since you do not seem to agree with alternative treatments, I respectfully ask that you find other threads to take part in and leave those of us who come here to support each other alone.

And Shirlynn, I respect the fact that you are a very caring person and want to help others, but I wish you would also respect the fact that those of us who have different opinions also are trying to help each other. It is obvious that you do not believe in alternative therapies, so I wonder why you are always posting on these threads. Your instincts are telling you that you have made the right choices for your BC, just as mine, and many others doing alternatives feel that we have made the right choices for us. I think you are more guilty of telling people they should follow your protocol than MarieKelley is. She is just trying to cite statistics. She has never tried to convince someone against radiation. The one thing that I will always regret, is that I went ahead and had rads when my inner voice was telling me not to. I had meltdowns week after week throughout it. I am still afraid of any long term effects. I still think it was a waste of time for me, and it cost me a fortune. We are still trying to cover the damn bills. I do not feel it saved my life. I feel that the lifestyle changes I have made are saving my life. You are entitled to take a drug or whatever, but I prefer to follow a different path. So please do not continue to try to talk others out of alternatives. We all need to listen to our hearts and do what we personally feel is best for us. No one else can make that decision for us. No one else should try to convince us that we are wrong, no matter what we choose.

Well Linda, probably the same reason's you post.  That is what this site is.  A place to post your opinions hopefully, without personal insults.  That doesn't get us anywhere and only shows that arguing is more important than facts.

This is not an "alternative medicine site".  And I post very seldom except where I see what I think is lousy advice being given to people.  Rads were nothing for me, at all.  I have never tried to talk others out of alternatives.  I think they are great.  I take 17 separate vitamins and herbs.  I just think sanity tells us this is a thing to do along with conventional medicine.

So try to keep the personal attacks down, they don't really help anyone.  If we are to have a true exchange of ideas, insulting people is childish.

Again, THIS IS NOT an "Alternative Treatment Site".  This was a site for discussion of whether or not people felt that rads were a good idea for small or early stage BC.  I myself have never and would never talk anyone out of anything.  But I also would not insult my fellow sisters.

Best, Shirlann 

LindaMemm wrote: Because of fear of litigation, lack of education about nutrition, and their emphasis on taking drugs for every problem, they just are not there to help those of us who want alternatives.

worriedhubby responded: "Another really stupid statement. Litigation has nothing to do with it although that is always the exuse of the truly ignorant. "

You're very wrong about that, worriedhubby. The fear of litigation has a chokehold on the delivery of health care in this country.  Everyday, day in and day out, physicians are delivering treatment and ordering bloodwork, various radiological exams and even sometimes surgical procedures that they likely wouldn't order if not for the fear of the litigation that could follow if they happen to miss something. They might feel 99.5 %  certain that  the testing will not show anything at all, but they order it anyway just in case. It's called CYA (cover your ass) medicine and it is one of the main factors responsible for the horrendous cost of medical care today. They would never tell this to you as a patient, but being a fellow health care provider, I've asked many a time "why are you doing that" and the answer is often "CYA". 

CYA is also one of the reasons why it's only a rare physician who will prescribe treatment contrary to whatever the current standard of care is...even if they personally happen to disagree with it. As long as they prescribe care under the standard, they can't be held legally liable for a bad outcome unless it was something extreme like gross negligence. Practicing medicine under a standard of care is sort of like an insurance policy - it's their sheild against a succesful malpractice lawsuit.. Going against the standard of care leaves their behinds wide open and flabbing in the breeze. Potential liability is a major influence on the way the practice of medicine is carried out.

Since it's getting late and I have to work tomorrow, I really can't spend any more time responding to your statements to Linda - although I'd like to. You seem to be so against alternative medicine. Not that this thread discussion about radiotherapy really has anything to do with that, but did you know that the National Institutes of Health has a Center for Complimentary and Alternative Medicine??  http://nccam.nih.gov/ 

Gee, I hope you don't think they're scumbags too.

Worriedhub. I wonder why you are posting so much and not your wife. You seem to be the kind of person who believes he is always right. I hope that you are allowing your wife to make her own decisions and you are not trying to control her the way you are trying to control us. Obviously you have a deep hatred for those who do not agree with you. Your rants do not deserve acknowlegement I will not longer give you the satisfaction of a response.

I will however say a prayer that your wife will have a speedy recovery and live  a long and wonderful life.

And Shirlann, I am sorry that you think I was being mean to you. As I said I respect your opinion, but you have constantly criticized me when I have suggested things that you do not agree with. As I said, we are all entitled to our own opinions. I respect your beliefs and I would hope that you would respect mine. I have never suggested to anyone that they should do what I am doing, but when people ask, I have given my opinion on what I am doing. We should not be against each other. We are all in this together. There is not just one answer, or approach to every situation and it is only fair that everyone here has a chance to learn from all sides so that they can make the decision that is best for them.

For what it is worth, my wife and I saw the Radiation Oncologist today and she starts radiation next week.  It never even occurred to us to ask her whether the radiation was necessary.  After all the reading I have done at this site and other sites, including published studies, it was clear that radiation was very much recommended.  No consideration would have been given by my wife to forgo that radiation.  Since we have two young daughters, I would not have allowed her not to have the radiation simply because she might have been influenced by a quack or quacks who think so much of themselves that they know more than the collective judgment of the best medical minds in the country.  She owes our daughters an obligation to do everything that she can to survive this disease.  Now as to her decision to forego chemotherapy, on the advice of the oncologist who said she didn't need it, I had no problem whatsoever.  I understood her reasons and clearly the risks of chemotherapy may have outweighed the benefits.  There is not a scintilla of medical evidence to establish however that the risk of radiation for her lumpectomy would outweigh the benefits.

Marie Kelley, as a response, First, I am all for alternative medicine so long as it is complementary to and not instead of standard medicine.  I detest the Charlatans as exposed by such sights as quack watch.  Second, doctors SHOULD follow the Standard of Care.  That is generally because it is based on the studies and judgments and experiences of the medical community at large.  If a doctor is going to veer off the Standard of Care, they should advise their patients of the same and make sure they get their consent, in writing.  And if they don't and there is a bad result, they SHOULD be responsible and held accountable.  Third, the general public makes far more of medical malpractice than the reality.  The reality is, as determined by nonbiased studies, that medical malpractice adds 2% to the cost of medicine.  Litigation has very little to do with the way medicine is practiced in this country.  THAT IS FACT.  But it is always easy to blame the lawyers.

Mariekelley wrote to worried hubby:

"I think you're mistaken in thinking that I'm the person who was blaming profit for the use of radiation in THIS thread.  I do believe it was poster mdb who was raising those concerns and I'm NOT mdb. "

Ha, well, worried hubby. I AM mdb.  And I WAS the poster that said that. And I'll just repost this link, again.

http://www.breastcancer.org/treatment/radiation/new_research/20060217a.jsp

The headline reads,Radiation Benefits Women with Small Cancers After Lumpectomy."

 Just read the article. It then went on, to say, EVERYONE should have radiation because it helps, by 2%.

The doctors. Covering their asses. 

Yeah sure. It helps the 2%. but the other 98% are needlessly, radiated.

And worried hubby, you don't think someone, is profiting? YOU are hopelessly, naive.

Although, lets just change the subject, have you gotten a PSA test, lately? For Prostate cancer?

So, if you have it, even though it's slow growing, it might make you impotent. The surgery, to take out the prostate cancer. 

Like breast cancer, SO MANY prostate cancers are just slow growing, and will never kill the man.

Are you willing to accept, that? Becoming impotent, to "nick the cancer, in the bud?" If you had prostate cancer? Even though, if you never had any treatment for your prostate cancer, you'd live a happy, sexually active, life. 

This is what you are telling your wife, to do.  To "cure" her breast cancer. 

So, I'm just asking,would you have the prostate cancer surgery? Knowing, you might become, impotent? 

The "doctors" all recommend it.  

And, they do.  

mdb 

Heidi, My tumor was the same size as yours but I had clear margins and nodes so I did not have to do chemo and that is why I am mad about doing radiation. It was obvious that my cancer had not spread and I felt that radiation was overkill. Your case is different,even though your tumor was small, the fact that you had a lymph node involved will effect your decision. I think you are smart to look at this before you make your decision. The fact that it is on the side of your heart is a concern. If your tumor is more to the surface, they can do a shallower radiation field and it will probably not affect your organs. Fortunately for me, the tumor was on my right side. I walked everyday after treatment so I never had fatigue and the buring was minimal because I was always slatering stuff on my breast and taking Vit E. and a few other supplements, which my radioligist okayed. The toughest part for me was emotional. Just going there every day was so tough. I was always losing it, even though I was in very little pain. But my walks after, were invigorating and helped me to get my head together. I am several months past treatment and for follow up I did a thermograph and my breast is still showing that it is hotter than normal. I also have a little pain and a pinching feeling under my arm. I have been lifting weights so maybe I am aggravating something but I am determined to get into shape. Whatever you decide, you will get through it. Just remember this is a time to put your needs ahead of everyone else and make getting well your priority. Prayers and hugs to you.

mdb, The stats you are relating is why I have been concerned about having rads. Since my tumor was in situ and I am post menopausal my chances of recurrance where low.I was not told this until I looked it up everything afterwards. And I believe that my weight loss(30 lbs), daily exercise, healthy diet and supplements are added insurance. And you are right about it being big business. My radiation bills were over 50 grand. Since my treatment went into a new year, we had to pay our large deductible twice. And I had a copay for every treatment. Even though I have good insurance, we are still paying the bills.

OMG-after reading all these posts about radiation I'm scared to death and wonder if I'm doing the right thing????  I had a lumpectomy in March with clear margins, just finished chemo and am scheduled for rads next week.  My med onco really recommended rads for me because of my Grade 2 tumor.....what to do, what to do???  The way I see it, there's no such thing as a "sure thing" and there's se's with everything!  I've always done what the doctor tells me to do, so with that said I'll probably do the rads and pray to God that they don't mess anything else up!

Good luck to everyone as you make your treatment decisions!

For any who really think they can forego radiation treatment with a lumpectomy, you may also want to review the "expert" at the ask an expert site of John's Hopkins, where Lilly says such things as:

When it comes to such an important decision, why would anybody consider the advice of lay people on this board who have axes to grind with the medical establishment.

Just like others are giving their opinion here...I have not read any post on this thread telling others to NOT do radiation.  But rather to post info so that each Person can make an informed decision.

Not true, there is at least one rabid poster on this board who accuses the medical establishment of gross fraud on the public, doing what they do not because they believe it benefits patients but for profit.  Several posters are in fact strongly recommending against radiation, as if there is a conspiracy by medical professionals to radiate even when not necessary.  This of course is all hogwash and plays on the fears of those who are on the fence.  The fact is that modern medicine at this time highly recommends radiation for lumpectomies.  The opinions of the lay people on this board who are anti-radiation, so far as I can tell, are worthless. 

Well dejaboo, I apologize if I have offended you, but not if I have offended the quack.  Primarily because I do not think these quacks are harmless.  I think the cause great harm for those people who are influenced by them to their detriment.  I refer back to my friend who was absolutely convinced by a quack holistic practitioner, that the treatment of cancer by the medical establishment was a fraud, generated only by their concern for profits, and that he would be much better off foregoing not only surgery, but radiation, instead taking the quacks nutritional supplements and who knows what else.    It is esasy to influence somebody when they are scared and hate the idea of surgery or radiation, the specter of cut, poison and burn.  I have no tolerance for quacks and I will call a spade a spade whenever and whereever I see them.