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Most Older Women Seem to Benefit From Radiation After Lumpectomy

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For early-stage breast cancer, lumpectomy followed by radiation therapy has been shown to be as effective as mastectomy without radiation for removing the cancer AND minimizing the risk of the cancer coming back (recurrence).

Radiation therapy given after surgery is called adjuvant radiation therapy. Adjuvant radiation therapy can destroy any cancer cells that may have been left behind after surgery, making recurrence in the same breast (local recurrence) less likely. Today, almost all women younger than 70 get radiation therapy after lumpectomy. Depending on the characteristics of the cancer, hormonal therapy, chemotherapy, and targeted therapy medicines also may be given after surgery to reduce the risk of the cancer coming back in the same breast or other places in the body.

Still, for women age 70 and older diagnosed with early-stage, hormone-receptor-positive breast cancer, treatment guidelines developed by the National Comprehensive Cancer Network don’t recommend radiation therapy after lumpectomy. This is because two large studies done in the early 2000s found no difference in mastectomy rates, recurrence, or overall survival between women who got only tamoxifen and women who got tamoxifen plus 6 weeks of radiation therapy after lumpectomy.

Now a new study is calling these treatment guidelines into question. Researchers at the University of Texas MD Anderson Cancer Center have found that radiation therapy after lumpectomy may help most older women diagnosed with early-stage, hormone-receptor-positive breast cancer avoid a later mastectomy.

The research was published online on Aug. 13, 2012 by the journal Cancer. Read the abstract of “Effectiveness of radiation for prevention of mastectomy in older breast cancer patients treated with conservative surgery.”

For this new study, the researchers looked at information on 7,403 women ages 70 to 79 diagnosed with early-stage, estrogen-receptor-positive breast cancer between 1992 and 2002; 88% of the women got radiation therapy after lumpectomy, the rest didn’t. The information came from a large U.S. National Institutes of Health database called SEER.

Within 10 years of diagnosis and treatment:

  • 6.3% of women who didn’t have radiation therapy had a mastectomy
  • 3.2% of women who got radiation therapy had a mastectomy

So women who got radiation therapy after lumpectomy were 50% less likely to have a mastectomy 10 years after surgery.

When the researchers divided the women into subgroups based on age and cancer characteristics, they found that all but one group got benefits from radiation therapy after lumpectomy. These groups:

  • women age 70 to 74
  • women age 75 to 79
  • women diagnosed with low-grade cancers
  • women diagnosed with medium-grade cancers
  • women diagnosed with high-grade cancers

all benefited from radiation after lumpectomy.

(Cancer grade is a score that tells you how different the cancer cells’ appearance and growth patterns are from those of normal, healthy breast cells.)

The only group that didn’t benefit from radiation after lumpectomy was women age 75 to 79 diagnosed with cancer that was either low- or medium-grade who had lymph nodes removed. Of these women:

  • 1.3% of women who didn’t get radiation had a mastectomy
  • 2.7% of women who got radiation had a mastectomy

This large study strongly suggests that radiation after lumpectomy might benefit many older women. If you’re 70 or older and have been diagnosed with early-stage, hormone-receptor-positive breast cancer, you and your doctor will consider the characteristics of the cancer, your unique situation, your surgical options, and your treatment options after surgery when creating your treatment plan. If you’ll be having lumpectomy and radiation therapy isn’t recommended, you might want to talk to your doctor about this study and ask why adjuvant radiation therapy isn’t recommended for you.

Using the most complete and accurate information possible, you and your doctor can develop a treatment plan that makes the most sense for you. You can learn more about radiation after breast cancer surgery in the Radiation Therapy section.

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