Do You Really Need Radiation? Maybe Not.
The recent completion of a long-term study involving the effectiveness of radiation and hormone therapy in curbing breast cancer recurrence yielded a startling result: for some older women, hormone therapy alone is just as effective as radiation followed by hormone therapy. If you’re a woman over age 60, newly diagnosed with breast cancer and potentially facing 5 to 6 weeks of radiation – read on.
For decades, it’s been the gold standard of treatment for women with hormone-receptive, early-stage breast cancer:
Surgery to remove the tumor. Radiation to eliminate any stray cancer cells in the breast. Hormone therapy to lower risk of recurrence.
Surgery is pretty much a given; it’s the first step most women take. For women with less aggressive cancer and/or one that hasn’t spread outside the breast, breast conservation surgery (a.k.a. lumpectomy) removes the only visible sign of cancer: a tumor.
Breast surgery is never easy, but lumpectomy is typically a straightforward, same-day surgery. Most women can be back at work and pursuing their regular lifestyle within several days.
Radiation, the next step for women who’ve had a lumpectomy, is basically a mop-up action, killing any cancer cells in the vicinity of the tumor; ones beyond the surgeon’s knife.
Radiation is usually a five- or six-week slog to the hospital five days a week. For survivors living far from their treatment facility, it’s a major disruption. It can mean missing work; having to pay for a hotel, and putting lots of gas in the tank – which, these days, can break the bank.
As if all that weren’t enough, radiation can be painful; think bad sunburn. It can also produce debilitating fatigue. And the cumulative effects of repeated X-rays, over the course of your life, can increase your risk of other cancers.
After radiation, hormone therapy is usually a piece of cake. Tamoxifen or an aromatase inhibitor (an AI, e.g., Arimidex, Aromasin, Femara), taken for five (or up to 10) years, works to reduce/eliminate the ability of estrogen to “feed” any cancer cells left in your body. Most women don’t experience any serious side effects from hormone therapy.
So who’s the bad boy in this triumvirate of treatment – the process that’s probably going to be the most troublesome?
That’s why a report released at an American Association for Cancer Research meeting this month is potentially good news for many older women diagnosed with breast cancer. The report, based on a study carried out by University of Toronto researchers, indicates that radiation offers very little if any benefit to certain women over age 60 with early-stage, hormone-receptive breast cancer.
Women whose cancer is ER- or PR-positive; HER2-negative; and with a low Ki-67 score (below 14%), if treated with surgery and hormone therapy, seem to receive no further benefit from radiation.
Ladies, the gold standard may be about to change. At least for some of us.
Since the study began more than 10 years ago, results are based on tamoxifen, the hormone therapy that was prescribed to all hormone-receptive survivors back then, regardless of age or menopausal status. Today, post-menopausal women are routinely prescribed an AI, found to be more effective than tamoxifen for women beyond their childbearing years.
Still, it would make sense that the same results would be obtained if the study were to be repeated using an AI, since that class of drugs does the same thing as tamoxifen: it deprives cancer cells of the estrogen they need to grow.
If you fit the criteria listed above, is foregoing radiation an option you might consider?
In my opinion, yes – with this caveat: study results are preliminary; and as mentioned, are based on tamoxifen, not an AI.
If you’re fine with undergoing radiation, then it’s certainly the safest bet at this point; its effectiveness has been proven over decades of research.
But if you’re on the fence – the hospital is hours away; you’ve had a bad experience with radiation in the past; or, for whatever reason, you simply have a strong desire to avoid radiation – then this study would be worthwhile discussing with your oncologist.
Bankhead, C. (2012, April 01). Some older breast cancer patients could skip radiation. Retrieved from http://www.medpagetoday.com/MeetingCoverage/AACRMeeting/31964