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May 20th, 2010
06:50 PM ET

Study: No radiation after surgery ok for certain breast cancer patients

By Miriam Falco
CNN Medical News Managing Editor

Older breast cancer patients who have their small tumors surgically removed get little benefit from radiation treatment, according to a study released Thursday by the American Society of Clinical Oncologists.

Researchers followed 636 women with early stage estrogen-receptor positive breast cancer, which is fairly common in older women. according to ASCO president Dr. Douglas Blaney.

The standard therapy for this type of cancer is to surgically remove the tumor, then give the women a drug called tamoxifen, which blocks the hormone estrogen, which can fuel tumor growth. The tamoxifen is then followed by intense radiation therapy to kill any remaining cancer cells.

All of the women in the study had a lumpectomy and got the hormone-blocking drug. Only half the women also went on to have radiation therapy – the other half did not.

Researchers found the survival was equal after just over 10 years.

"Avoiding radiation is feasible,” study author Dr. Kevin Hughes concludes based on the results.

The impact of these study results could be quite dramatic for breast cancer patients.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, believes the results of this study "will be practice changing,” meaning that it is likely to become the standard treatment for some of these patients.

"Getting the women to the doctor every day for six weeks is very difficult," says Brawley. "One-third of women drop out from radiation after two to three weeks."

Dr. Douglas Blaney, president of ASCO, didn't go so far. He thinks the research is "possibly practice changing" and says when women find out how small the radiation benefit really is and choose to defer getting it, "this gives us some comfort as physicians in supporting our patients."

The study also found only 7 percent of the women in this trial who already passed away actually died from breast cancer, leading Hughes to conclude "death from [this type of] breast cancer is a very rare event for women with very small tumors.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (38 Responses)
  1. caz

    I feel, that for some ladies not having to have radiotherepy will take away a lot of stress, Not only from getting the treatment, but it will also lower the potential worry about its return. I myself had chemo as well, and feel the more treatment you get the bigger the worry. So by reducing the amount of treatment will make it easier for some women to get on with their lives, safe in the knowledge "it was caught in time"

    May 21, 2010 at 05:06 | Report abuse | Reply
  2. Liz

    I was diagnosed with DCIS and had a lumpectomy three years ago. I declined radiation. I felt the risk of damage to heart and lung tissue that the radiologist explained to me was not something I was willing to accept. I continue to take anti-hormone therapy and I'm fine. Thanks for validating my gut feeling about radiation.

    May 21, 2010 at 12:37 | Report abuse | Reply
    • Pil

      Thank you Liz for posting your experience. I willl not be getting the radiation either because it would be directly over my heart and lungs.

      September 5, 2011 at 22:46 | Report abuse |
    • Stasia Bell

      Liz I was thinking of doing the same thing.i am70 yrs.old .i am afraid of the radiation.and what it will do to me. So I think I am going to do what you did.i rather die later then sooner. Thank you.

      April 23, 2017 at 13:42 | Report abuse |
  3. Marjorie

    I had a lumpectomy two years ago. The growth was contained in a milk duct which I was advised meant very little chance of reoccurrence or spread but nevertheless followed by 30 shots of radiation which wiped me out. I now have another growth on the same breast which has been found to be benign via a MRI and, according to current medical practice, therefore unoperable. If it does turn malignant as per previous growth, I have been advised radiation would not be necesary.
    lso,being a senior citizen, cancer is not aggressive, they say. I translate this to mean "you'll probably die before treatment is necessary" Any comment?

    May 21, 2010 at 14:31 | Report abuse | Reply
  4. ineke saenen-salo

    I have(had) grade III prog/estrogen/HER2 neg cancer in my left breast. I received 6 chemo treatments followed by a recent lumpectomy. I do not have the pathology report from that yet. What are your thoughts about the need for radiation in this situation?

    May 21, 2010 at 18:24 | Report abuse | Reply
  5. addy

    what counts as an "older woman"? over fifty? Over sixty? Over seventy?

    May 21, 2010 at 19:08 | Report abuse | Reply
  6. Shereef Elnahal

    As we have seen with the recent USPSTF guidelines, alterations in both screening and treatment won't be met without resistance. Patients and health care professional stakeholders will need be brought to the table before such changes will be accepted, especially if the changes involve removing a treatment measure from the list of things we can do for patients with breast cancer.

    Please visit my blog on the business of health care in America:
    http://www.shereefelnahal.com

    May 22, 2010 at 01:59 | Report abuse | Reply
    • jan bright

      I never heard about these guidelines before. thanks.
      The doctors like to keep everyone in the dark.

      January 25, 2011 at 11:53 | Report abuse |
  7. Sandra

    The quality of my life has gotten MUCH worse since radiation. I will spare you what I really think.

    May 23, 2010 at 23:57 | Report abuse | Reply
  8. Sandra

    Thanks for this article. It confirms what my gut thought, but didn't follow, and I deeply regret that. The quality of the information that I was given to make a life decision was just flat lousy. I think the scientific community knew more at the time, but I was given different information to make a decision with (I was told that "if you only have the lump removed, you have to have radiation". "That's the rule." It's my body...how can they make a rule like that? I thought I would just have the lump surgically removed and never go back. Figured they would fuss about compliance if I did that. It's a very stressful thing to go through that diagnosis. I needed a doctor to be on my side. With hindsight, I think they worry about paying for machines and such. It wasn't about me. They didn't care one speck about me or my health.) I seriously regret that I didn't follow my gut.

    May 24, 2010 at 00:41 | Report abuse | Reply
  9. marie willey

    Does this refer to cancer in situ or invasive cancer?

    May 24, 2010 at 02:55 | Report abuse | Reply
  10. Dial from SoCal

    I had a lumpectomy and radiation 15 years ago. Some months later the doctors thought the cancer had metastisized to my lung and did a thorochotomy....turns out I didn't have more cancer, I had lung tissue damage from the radiation.
    No more radiation for me! Oh, and by the way, I firmly believe that
    hormone replacement therapy triggered my breast cancer.

    May 26, 2010 at 01:41 | Report abuse | Reply
  11. R. Carella, M.D.

    While I don't have time to address all inaccurate statements, I would like to state the following: In 40 yrs. of practice in Radiation Oncology, specializing in breast cancer, I would estimate far less than 1% of my breast pts. have ended radiotherapy before the planned dose due to skin reaction. Also, with IMRT, Respiratory Gating and other modern measures, treatment can, and should, be effectively delivered without treating the lungs or heart.

    May 26, 2010 at 12:29 | Report abuse | Reply
  12. John Norlund, MD, FACRO

    Dr. Brawley,

    I have practiced radiation oncology for thirty years and during that time
    directed the breast cancer treatment of over three thousand women. No more than a handful abandoned therapy. My curiosity than is the unique circumstances of your patients, a third of whom abandoned
    irradiation "after two to three weeks." Since I am on sabbatical, I
    would be happy to review your data on-site. Regarding the subject of
    omitting irradiation of the involved breast, your findings are in keeping
    with the CALGB study published in the NEJM nearly 6 years ago.

    May 26, 2010 at 13:39 | Report abuse | Reply
  13. Cocococo

    I had a lumpectomy in May 2010. The pathology report was brilliant – if you are unlucky enough to have breast cancer,mine is the one to have. Its super slow growing, cribiform and more than 90% tubular etc etc. My Oncologist put it in perspective by calling it a trivial cancer and warning me the greatest danger I faced was overtreatment. We both had separately crunched the stats based on the histopathology report using Adjuvant Online and we both came up with the same stats. He recommended no hormone therapy and no chemo as based on my stats, I would only enjoy a 0.33% of 1% benefit from it BUT face a 4-6% risk of morbidity and mortality [probably even higher than this]. Then I went to see the Radiation Oncologist. A more condescending and unhelpful sod could not exist. I was "managed"in a manner I found coercive and deeply unpleasant with one aim clearly in their mind – provide me with so little information, terrorize me into submitting to their treatment recommendation.Which was – unbelievably – the full blast six weeks whole breast radiation with boost. Ie., exactly what they recommend for almost everyone. I was given no options such as partial breast radiation or less damaging radiotherapy. I had to press hard to get any useful medical facts.After a lot of pressure and me being very, very directive and insistent, some hard stats [verbal, nothing in writing as I got from my Oncologist] finally emerged. I had a 95% chance of no local recurrrence of breast cancer. If I had the nuclear blast radiation he wanted, my LR risk would be boosted to 98%. Yes folks – they wanted to radiate my whole breast for a measly 3% benefit! I would face a pile of negative consequences from the radiation – no inocuous sounding skin irritation, but serious acute radiation induced dermatitis for which most so called treatments do not work, skin retraction, bllisters, ulcerations – the list goes on. Then there is the damage to other organs especially the lungs [which often show up on x rays as suspected cancer recurrence due to scarring] and heart disease. Then there is the fact – not revealed to me in the meeting which discovered on my own – that radiation is a one shot deal. Once the full breast is radiated, then if there is a recurrence, that breast cannot be radiated a second time. So they wanted me to use up my one shot deal on a trivial cancer and so rule it out if a worse form occured in future!! I also read about how radiation can increase cancer in the contralateral breast. The most appalling fact I discovered on my own and never revealed to me by the radiation team, was that radiation for my breast cancer had no statistical effect on my mortality ie., death rate.In fact, I found studies showing women with breast cancer who had radiation had a HIGHER death rate from non-cancer causes compared to women with breast cancer who had no radiation. So call me cynical but is it not possible to posit that radiation itself could account for the higher death rate? My question though is this – how legally can the radiation ëxperts get away with failing to disclose medically pertinent facts when engaging with women in order to obtain our informed consent to radiotherapy? The legal position is clear – all such facts must be disclosed and the raditherapist and/or their employer is liable if they are not and damage results. I found the radiologists supercilious, smug condescending and the worst medical professionals I have ever dealt with. They are radiation zealots who appear to delight in deliberately keeping women in the dark and ignorant about the real benefits versus risks of radiation in order to keep us compliant to their treatment plans.I have overheard them commmenting that if you tell women too much, they are more likely to choose not to have radiation.. As Homer Simpson would say DÓh. The solution to getting women to have radiation IS NOT to use trickery , deceit and weasel language to obscure the reality. It is to impart the facts and list the options, with pros and cons attached, so we can make up our own mind. As adults are entitled to do. I would prefer a spread sheet anyday with all this material any day in preference to the waste of time involved with meeting with the radiation oncologists.

    July 30, 2010 at 01:56 | Report abuse | Reply
  14. Rachel

    I am a post lumpectomy patient struggling with what I should do now. I am very skeptical about everything that has been thrown at me... radiation, maybe chemo, maybe hormone pills, as my post lumpectomy procedure. Personally, I just wanna say "F*** IT" and take my chances. I'm told that I'm cancer free...so I just wanna run with that. Am I stupid for even considering doing nothing now?? By the way, I'm 41 with no breast cancer history in my family. Thoughts??

    July 31, 2010 at 01:45 | Report abuse | Reply
    • Cindy

      Hi Rachel, I am in almost exactly the same position. Had my lumpectomy 4 days ago along with removal of two lymph nodes. The tumor was 1.7 cm. The preliminary findings during surgery were that it had not spread to the nodes, although they still have to byopsy the entirety of the nodes. It's so strange, when I got home from the hospital I decided that I was not going to have radiation or anything else. I will find out in a couple of days if there were any cells that had invaded the rest of the nodes. I say F it . I will see what they have to say but seriously doubt that I will have further assult to MY body. Good luck to both of us. Cindy

      June 27, 2011 at 18:20 | Report abuse |
    • Ellen

      What did you end up doing? I had a lumpectomy 3 days ago, and the pathology results are not in yet, but the doc said the cancer hadnt spread to my lympth node.I have a post op appt in a couple weeks, and theyd already mentioned the standard radiation, and hormones since my invasive ductal cancer is feed by hormones. I am very holistic and dont want any further treatment, I am 52 years old and still prob a year away from menopause. Please send your thoughts and experience.

      July 28, 2017 at 19:54 | Report abuse |
  15. terry

    what age is considered an older woman. I had dcis .2 lumpectomy removed in july with clear margins.and grade 3 comedo necrosis. There is no family history of bc. I am 57 years old and don't want to have radiation. please reply

    September 9, 2010 at 11:31 | Report abuse | Reply
    • LILY

      I am with you. I am very confused as to what treatment I should follow. I had my specimen sent out for genetic and come to find out I am low high risk and I am supposed to take chemo, radiation and follow all these with hormone pills for a good 5 years. I feel like forget this cos I HAVE NO FAMILY HISTORY and the lump was less than 1cm. what is going on with all these medicines they want to pump into us my margins were clean and all these treatments scare me more than help me... Goodluck to you

      November 26, 2010 at 23:54 | Report abuse |
    • Holly

      I am you! Almost exact situation: lumpectomy, clear margins, 'high grade' DCiS. I have an appt tomorrow with a squad of doctors to try to convince me to follow 'standard' protocol – radiation and drugs. I am digging in and not agreeing with them. Why treat something that is gone? I really really want some support for a plan of due diligence with increased mammograms. I am not hopeful and expecting a grueling day of scare statistics. I am armed with my own tho! Hope to hear from others,

      January 4, 2011 at 14:09 | Report abuse |
  16. Elayne

    Hi I am so freaked out over the thought of having radiation. I am coming up to bat with my decision, and have to make it quick. It has been 5 weeks since my final chemo. I have had 11/12 Taxol treatments. I had A/C 4 rounds before surgery in July. After surgery all margins from original tumor was clear. Tumor was 2.0 x 1.5. 6 lymph nodes were involved. one as large as 3.0 ally 17 nodes were removed. Taxol follewed 4 wks. later. I could not do the last taxol because of pnuemonia. Radiation gravely concerns me. I would like to think with diet and hormone therapy I can avoid it. What do you think?

    December 15, 2010 at 12:12 | Report abuse | Reply
  17. Bryant

    Hi I have taken the rounds of radiation and chemo after my brain surgery back in June of 2009. My brain cancer was 5x5x7 in size and was diagnosed as a grade 3 during the operation, with the leftovers being possible grade 4. Radiation successfully froze and shrunk the remaining cancer and I am a happy cancer survivor presently.

    January 4, 2011 at 14:21 | Report abuse | Reply
  18. Sharon

    Hello, I just had a lumpectomy to remove dcis. My margines were clean and my cells were contained and were noninvasive. I thought I was okay, they are suggesting radiation also. Has anyone done just the hormone treatment without radiation? Thanks for your thoughts.

    November 3, 2011 at 21:46 | Report abuse | Reply
  19. Debra Carter

    Hi Everyone, I was diagnosed Breast Cancer on Sept 16th, I had surgery on Oct 6th. The type of cancer that I had was Invasive lobular carcinoma. They removed a 3cm tumor. They did not get clear margins, so they went back in today and removed more tissue. Clear lymph nodes. I am to see the radiologist oncologist on Thursday. I have started on a special cancer diet. No sugaror carbs, and I only drink water or green tea. I am a firm beliver that you can heal yourself from the inside out . I have been told that they is a dirrerent type of radiation therapy. It is called mammosite where they insert a cather with radiation seeds and you will get radiation for onlly one week twice a day. This keeps the radiation from damaging your other cells. I am not too keen on any type of radiation. I know it damages your skin and can damage your internal organs.. I also have a great concern about the oral treatment with tamaxofin. If anyone has any guidance, would greatly appreciate it.

    November 29, 2011 at 22:27 | Report abuse | Reply
    • Maggie

      I am a little familiar with the radiation treatment that you are referring to. My surgeon called it brachy radiation. It is supposed to only last for just 5days and directly treats the remaining –if any-cancer cells. I have good insurance and blue cross ppo won't pay for it. I had a .6 mm tumor removed with no lymph node involvement. I need to meet with radiology oncologist next week. I too would love to skip the RAD treatment. I am 47 with no other health issues. Blue cross will only pay for the traditional RAD treatment. Curious what you decided on for your course of treatment?

      January 16, 2012 at 23:51 | Report abuse |
  20. Jen

    I am happy to find this group. I had breast cancer surgery on 11/11/11. I have not had the funds or insurance to do anything else since. I have been saving for the Obama insurance and to have all the deductible many and co-pays – but, feeling very uneasy about doing radiation or chemo. I don't know what to do. It has been 3-months since my surgery. Margins were clear but, they insisted I would have to have radiation for sure and possibly chemo.
    Have I waited too long?
    Has anyone read Suzanne Summers book KNOCK OUT? (about alternative cancer treatments and things the medical professional does not tell us.)
    I am worried not to have the treatments – but, worried to have them.
    Thanks for sharing. Never wanted to be in this club – but, glad to have others to talk with who understand my deep
    fear and feelings.

    February 21, 2012 at 23:33 | Report abuse | Reply
    • Brenda

      Research Black Seed Oil (Nigella Sativa)

      March 27, 2015 at 00:26 | Report abuse |
  21. Jennifer D

    HELP!! I am so stressed about my decisions. I just had a lumpectomy about 6 weeks ago for my invasive ductal carcinoma. My tumor was only .7 cm and my lymph nodes were clear. My first margin had DCIS in it, my second one was clear. My oncotype score has me in the intermediate range of 24 with a distant reoccurence at 16%. They don't know if I would benefit from Chemo. I am being told if I don't do a mastectomy then I have to do radiation. Radiation scares me, I don't know if the risks outweigh the benefits for my situation. Would I be crazy to just keep my lumpectomy and skip radiation and only do the Tomoxifen?????

    September 8, 2012 at 02:15 | Report abuse | Reply
  22. Matilda C

    I had rt. localized infiltrating (invasive) breast cancer 35 years ago at age 42; had a modified mastectomy and then an oophorectomy since the tumor was estrogen dependent. No problems until six months ago, I had a lumpectomy in left breast (6 mm invasive localized, clear margins, clear sentinel node. Now, six weeks of radiation recommended. I am terrified to have the radiation and cannot have the estrogen suppressor pills since I already have osteoporosis. prefer to I had a series of health issues that caused much stress in my life before this second diagnosis and I truly believe that caused the new growth. My immune system protected me for 35 years but broke down. I would prefer to build up my immune system as the best defense. I am almost 77 years old. Ironically, the first tumor grew at age 42; both at 7 year cycles in my life. I would like to give my body a chance to fight back again without having radiation further break down normal cell tissues. Please advise.

    December 10, 2013 at 20:36 | Report abuse | Reply
  23. Brenda

    Research black seed oil (Nigella Sativa)

    March 27, 2015 at 00:27 | Report abuse | Reply
  24. Brenda

    research Nigella Sativa ( black seed oil)

    March 27, 2015 at 00:30 | Report abuse | Reply
  25. Nancy

    Help! I had a lumpectomy three weeks ago. My tumor was 3.1 cm, invasive ductal carcinoma. My lymph nodes were clear and clear margins. My oncotype score is 26. I'm told by my oncologist that my cancer is high risk. I've had a pet-scan, showing no other cancer in my body. I've been told I need to do radiation (possibly 4-1/2 weeks) and go on a hormone blocker called Anastrazole for 5-10 years. I don't want to do either. Any help or suggestions would be very helpful. I'm afraid of the damage that can be caused by the radiation. Thanks for any thoughts.

    July 9, 2015 at 21:45 | Report abuse | Reply
  26. Barb

    I'm having a lumpectomy in 2 days, I was diagnosed with hers 2, invasive cancer, I'm thinking after the surgery not to do chemo, radiation, or hormone therapy, what are my chanes of living? Please someone help, im thinking this will make me worse by doing all the after treatments, if they remove the tumor and lymph nodes, why go thru all the other treatments??? Thanks!

    September 12, 2016 at 22:03 | Report abuse | Reply
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