A recent study by researchers at Wake Forest University School of Medicine indicates that older women (defined as over age 65) who’ve had a lumpectomy can dramatically reduce their risk of both a cancer recurrence, and new tumors, by undergoing radiation therapy; and by taking tamoxifen, a drug that blocks the effects of estrogen in the body, for five years. While these treatments are pretty much “standard of care” for younger women, older women aren’t as likely to receive them.
The Wake Forest study reports that the older woman who doesn’t have radiation after her lumpectomy is 60% more likely to develop cancer in the other breast than her counterpart who does have radiation, and 3.5 times more likely to have a recurrence in the same breast. In addition, older women who either didn’t take tamoxifen, or took it for less than a year, ran a 90% higher risk of recurrence than older women who took a full 5-year course of the drug.
Older women are more likely than younger to get breast cancer, anyway; and as the population of this age group increases, these facts will have more and more bearing on all of us.
What’s going on here? I don’t know why older women aren’t getting radiation, or taking tamoxifen, at the same high rate as younger women. But if you’re an older woman reading this–or you have personal experience with an older breast cancer survivor–maybe you know.
Perhaps health insurance was a perceived issue; even with Medicare coverage, some older women may feel unable to navigate the paperwork involved, or may not quite believe that their insurance will cover the cost,of either radiation, or drugs. Perhaps the woman feared radiation’s side effects; having heard horror stories of burned skin, stiffened breast tissue, and long-lasting, flu-like symptoms, she chose to take her chances with a recurrence.
Heck, maybe it was even the fact she’d have had to get some tattoos and lie half-naked on a cold table with a bright light shining down on her breasts, that steered our hypothetical older woman away from radiation. And as for tamoxifen–the documented side effect of bone loss could be enough to tip the scale for a woman in her 70s who’s already terrified of falling and breaking her hip.
If you’re an older woman undergoing treatment–or you’re a younger woman helping an older friend along the cancer path–these issues are worth considering. Have you (or your friend) been given the option of radiation and tamoxifen, post-lumpectomy? If not, ask your doctor why not; there may be a good reason and, if so, you should know it. Have you been given the option for treatment, but refused? If so, was your refusal based on a reason strong enough to overcome the fact that you’ll probably have a much higher risk of cancer coming back, or a new cancer developing?
I don’t have any answers here; and I’m certainly not advocating, one way or another, for or against treatment. I’m just suggesting that, in light of this new information indicating radiation and tamoxifen can, indeed, help older women prevent cancer, that the decision to forego treatment–either by doctor, or patient–should be a considered one. As Ann M. Geiger, lead author of the Wake Forest study summed up, “Based on our findings, we recommend that mastectomy, or lumpectomy with radiation therapy, along with adequate duration of hormone therapy for women with hormone-responsive tumors, be considered standard therapy in women of all ages and health conditions, except for those with very limited life expectancies.” In other words, it ain’t over till it’s over. Don’t let age alone be the chief determining factor in your cancer treatment.