Breast Cancer in Women Over 70: Treatment Decisions

PJ Hamel Health Guide
  • 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…

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    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;
    •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.

  • Chemotherapy is a much harsher treatment than radiation, and as such requires serious consideration of risk vs. gain.

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    How do you determine how much risk, vs. how much gain?

    First, ask your oncologist if you’re a candidate for the Oncotype-DX test, which is a genetic test that can determine how likely your particular cancer is to respond to chemo. If your score is under 19, you should be able to skip chemo. If it’s over 19, then you need to consider the following:

    •Breast cancer in older women is, in general, much less aggressive than it is in younger women, and thus less likely to need chemo’s “strong medicine.”
    •Most breast cancers are slow growing. Without treatment, a recurrence or metastasis could occur at any time; but it’s more likely to take many years, if it happens at all.
    •Chemo comes with side effects ranging from mild to deadly; there’s no way to predict ahead of time the severity or type of side effects you’ll experience.
    •Studies show that chemo in older women is often less effective than it is in younger women; there’s less “upside,” more downside.
    •Older women may have underlying health issues (cardiac problems, a weakened immune system) that chemo would exacerbate. 

    For more information about this tough decision, read Chemotherapy: Is It Always the Best Choice?

    No one wants to endure any more cancer treatment than necessary. As you get older, and good health becomes harder and harder to maintain, it’s worth thinking seriously about exactly how much you’re willing to physically endure to increase your lifespan – perhaps only slightly, perhaps not at all.

    Have a frank discussion with your doctor about your diagnosis, and how much and what kinds of treatment are likely to help (vs. what side effects you’re likely to experience). Once you’ve met with your doctor, take what you’ve learned and have this same discussion with your family.

    Both doctor and family want to keep you alive, probably at all costs. But it’s your body, and your life; only you can decide if the challenge of side effects, some of which could last for years (or forever), is too high a price to pay.

Published On: June 22, 2011