The annual San Antonio Breast Cancer Symposium (SABCS), held every December, is the world’s largest gathering of breast cancer researchers and medical caregivers. Much of the news coming from the symposium focuses on research breakthroughs whose effect will be felt far down the road, if ever. But some of the news is actionable for the survivor community right now, including the following.
Radiation: Older women may choose to skip it
Radiation has long been a common part of breast cancer treatment. Radiation follows breast conservation surgery (lumpectomy) as surely as lunch comes after breakfast.
But thanks to new research, results of which were presented December 11 at the SABCS, some women might reasonably consider forgoing radiation. Why? Its benefit may be so negligible that it isn’t worth the cost: physical, emotional, and financial.
The six-year international phase III PRIME trial, conducted by researchers in Great Britain, focused on breast cancer treatment for women age 65 or older with early-stage cancer. Women in the study had hormone-receptive cancer that hadn’t spread beyond the breast; had undergone a lumpectomy with clean margins; and were prescribed follow-up hormone therapy.
The randomized study delivered radiation to half the women, while half received no radiation. And the results, 5 years later, were startling: although women who’d had radiation did enjoy better outcomes, the difference in outcomes between the two groups was tiny.
In the group receiving radiation, 97% of women were still alive after 5 years; and 98.5% of those survivors had experienced breast-cancer free survival (no recurrence).
Compare that to the group that had skipped radiation: 96.4% remained alive at 5 years; and 96.4% of those survivors had experienced breast-cancer free survival. ("Avoiding radiotherapy," 2013)
Looked at another way, of every 100 women in the study, 95 had received radiation needlessly; they would have survived without a recurrence anyway. And considering the cost of radiation - 5 to 6 weeks of almost daily visits to the hospital; pain and burns; fatigue; an increased risk of other cancers, and the financial cost - that’s significant.
Another takeaway from the study is meaningful, as well. Since breast radiation can only be done once, the tiny number of women who had a recurrence were unable to have radiation to treat it a second time. If those same women hadn’t had radiation the first time around, they could have used radiation as part of the treatment for their recurrence.
How does this research affect you? If you’re a woman age 65 or older diagnosed with breast cancer (or if you’re supervising care for an older woman - your mom, an aunt); and you meet the criteria outlined above, eliminating radiation as part of the treatment plan is a reasonable option to consider.
Aromatase Inhibitors: Relief from joint pain
A common part of breast cancer treatment for most survivors (70%) is hormone therapy: 5 to 10 years of drugs that inhibit the female hormones responsible for feeding breast cancer cells. This therapy includes tamoxifen for younger women; and an aromatase inhibitor (AI; Arimidex, Femara, Aromasin) for women who’ve been through menopause.
While these drugs do have a significant positive effect, reducing both risk of recurrence and breast cancer death, they come at a cost. Women taking tamoxifen often gain weight, and are at higher risk of endometrial cancer and blood clots. Women on AIs usually experience bone loss, sometimes significant enough to demand drug treatment; as well as bone and joint pain, which in some cases is severe enough to impact daily activities.
Researchers at the Yale Cancer Center, backed by funding from the National Cancer Institute, conducted a year-long study involving breast cancer survivors being treated with an AI. All had reported bone and joint pain, ranging from mild to severe. Half the women were assigned to an exercise program: twice-a-week resistance training (e.g., weightlifting, resistance bands); and 150 minutes a week of moderate-intensity aerobic activity (e.g., brisk walking). The remaining women didn’t follow an exercise program.
By the end of the year, the number of women reporting drug-related pain had dropped 20% in the group assigned to exercise, compared to the non-exercising group. The benefit was strongest in women who’d attended 80% or more of the resistance-training classes, and had experienced a 5% or greater increase in their cardio-respiratory fitness (i.e., they pursued aerobics seriously enough to make a positive difference).
While 20% improvement may not seem like a wildly successful outcome, it’s a start. And for women experiencing constant pain from their daily Femara tablet, the chance that exercise may help alleviate that pain is worth taking - because even if their pain remains undiminished, they can be sure their overall health will improve.
Exercise improves drug-associated joint pain in breast cancer survivors. (2013, December 12). Retrieved from http://www.sabcs.org/PressReleases/Documents/2013/be92c6ca5d4070f7.pdf
Avoiding radiotherapy is an option for some older patients with breast cancer. (2013, December 11). Retrieved from http://www.sciencedaily.com/releases/2013/12/131211142101.htm