While you’re much more likely to be diagnosed with breast cancer as an older woman than you are when you’re under 60, treatment advice often focuses on middle-aged or younger women. Older women undergoing surgery, and making choices about radiation and chemotherapy, have different challenges – first in learning all they can abut possible treatment; and then in deciding what kind to have… or whether to have it at all.

Are you a newly diagnosed survivor over age 70? Read this post for guidance around treatment decisions.  

Q. I’m an older woman, and have just been told I have breast cancer. I’m very worried about having chemo and radiation…

Let’s start at the beginning. Most women have surgery prior to any other treatment. Your doctor will likely give you a choice of having a lumpectomy (breast conservation surgery); or a mastectomy, removal of the entire breast.

How do you decide which option is better for you? Consider the following:
•The survival rate is about the same for both;
•Lumpectomy is a fairly simple same-day surgery, with a quick recovery time; but it’s nearly always followed by radiation, which can last up to 7 weeks;
•Mastectomy doesn’t usually require radiation. But it’s aggressive surgery; recovery can be difficult if you’re on your own, without someone to help with day-to-day tasks; and you lose your breast, which could mean more surgery, if you choose reconstruction.
 
Once you’ve recovered from surgery, and your oncologist has a complete diagnosis based on your pathology report, you’ll discuss the next phase of your treatment.

If you’ve had a lumpectomy, the usual course of treatment would be radiation. Most women tolerate radiation very well, and don’t think twice about having it. The chief downsides are:
•Having to go for treatment 5 days a week for up to 7 weeks;
•Fatigue;
•Sunburn-like pain and skin irritation.

For older women, there’s one other factor to consider, and it’s important: studies show that for women 70 and older, radiation reduces the risk of recurrence, but doesn’t affect survival rates. In other words, radiation doesn’t reduce your risk of dying from breast cancer.

In addition, recent research shows that for women with early (stage I), hormone-receptive cancer, risk of recurrence after radiation is 2%; without radiation, it’s 8%. A recurrence could happen within a year; it might happen in 15 years; or chances are excellent you’d remain cancer-free, with or without radiation.

Should you have radiation? At your age, it’s not a given; consider your decision carefully.

And what about chemo?

If the cancer was caught early, and hasn’t spread outside your breast (which your surgeon has determined by removing and testing one or more of the lymph nodes under your arm), then your doctor probably won’t recommend chemo.

But if it’s spread to at least one lymph node – or if it’s triple negative (neither hormone-responsive, nor HER2-positive) – then your doctor may very well recommend chemo.