Often in my practice, women would ask after their lumpectomy for breast cancer if they really needed the proscribed radiation therapy. I always said yes. It would lower the chances of the cancer returning in that breast. But, I didn’t think it was life-saving. So I wouldn’t worry if older women wanted to opt out. The radiation was a lot of trouble. Daily visits over the course of 6 or 7 weeks was a major effort for them. And, after all, their tamoxifen should lower their chance of a recurrence.
I was wrong. This week (Nov 12) in the British journal Lancet, a group of researchers from Oxford analyzed all the work ever done on the benefit of radiation therapy to the breast after lumpectomy. They found that not only does it lower the chance of recurrence in the breast, it also lowers the women’s chance of dying from the disease. And this applied across the board. Old women, young women, on tamoxifen, off tamoxifen. No matter what the situation, radiation was better than no radiation.
All the studies these researchers analyzed were head to head studies that compared women who received radiation after lumpectomy to those that didn’t. In general the rate of recurrence was lowered by half in women who received the radiation. Most of these recurrences were in the breast that had the cancer. But recurrences elsewhere were also lowered, which led to four percent fewer deaths – that is, for every hundred women there were four fewer deaths. That is a lot.
Why is radiation is necessary after the cancerous lump is removed? Look at the origin of the word, perhaps from Hippocrates, to whom breast cancer resembled a crab, which in Greek is cancer. Think of a crab with a central core body and legs sticking out from this center. Well, the surgeon will remove the body of the breast cancer but will the surgeon remove all the legs? Maybe not. That is why radiation is important. We think that if it did come back, we could catch it in time, but maybe not.
So get your radiation. No excuses
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Are you wrong Dr. Kattlove? Radiation may not be needed, at least for elderly women with early-stage breast cancer, and may be able to safely skip radiation treatments, another study suggests.
The researchers came to this conclusion after comparing two groups of elderly women treated for small cancers. One group was given tamoxifen after undergoing lumpectomy, while the other got tamoxifen and radiation. The finding reported in the New England Journal of Medicine, means some older women may be able to avoid the time and expense of radiation treatment, as well as possible side effects such as breast and arm swelling, breast pain, and poorer cosmetic results.
Even though giving radiation after a lumpectomy can delay a relapse of breast cancer, it does not seem to improve overall survival. Radiation therapy still has the potential to damage the heart, even though modern techniques have made the treatments safer than ever. In some clinical studies, women who had radiation in addition to tamoxifen reported worse breast pain, swelling, and cosmetic outcomes in the first few years of follow-up compared to women who took only tamoxifen.
Dr. Kevin Hughes, the lead study author felt that if a patient does not need to have radiation therapy, their quality of life can improve significantly. The researchers noted that women who received radiation therapy in addition to Tamoxifen were less likely to have their cancer return in the same breast or nearby tissue. However, elderly women already have a low risk of recurrence because their breast cancers tend to be less aggressive at that age, without the added toxicity profiles of radiation (New England Journal of Medicine (Vol. 351, No.10: 971-977).
I appreciate the comment and agree that Dr Pawelski is correct as far as the data go. But the data only covered 5 years while the Lancet article went to 15 years. And, as best I can tell from the article, radiation prolonged the lives of 70+ year old women. So, in older women one has to ask how long they are expected to live or want to live. Bottom line for docs and patients - have an open discussion of the benefits and harms of the radiation treatment
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