Pro and contra radiation

[nelly8]

Hello, thank you for your answers. All the history of my cancer has your inputs. Now I've got a post-op biopsy. I had .8 invasive DC, hormone positive, agressiveness 5/9, nuclear grade - medium, 18 nods clear, cuts clear. I haven't met oncologist yet (1 month after operation), but I am thinking to refuse chemo and hormons (3% of survival increase). Now I have doubts even for radiation, because I see myself in high risk group: tumor was located almost in the middle of the chest and my breast are small, so I will have a big part of heart and lung area irradiated. Can you help me to assess the suvival for my case (small tumor) without radiation. What's the scenario if I get recurrence in 3-5 years in the same place? Mastectomy and chemo? Can be done mastectomy on irradiated tissue? Thenk you.

[surgeon]

Nowadays, unless the person has a very unusual chest wall, the radiation to any area but the breast itself is very minimal and should NOT be a reason to refuse radiation. Some women will do fine with removing the lump and no more treatment of any kind. But it is taking a BIG risk. Except in a very old person or a very ill person who is felt to have a much shortened life expectancy for other reasons, lumpectomy alone is a VERY risky and inappropriate choice. A woman who wants the best chance of cure MUST choose eithe lumpectomy with radiation, or mastectomy. There is no doubt about that. In the hundreds of women I've seen treated with radiation in the new techniques, I've NEVER seen problems with heart or lung radiation. Chemo is a more difficult issue. Your chance for cure (assuming proper treatment of your breast) is already very good, and would be improved more, but not dramatically more, by chemo/hormone therapy. We have no way of knowing which people treated are getting their lives saved, or which are going through it unnecessarily.

[CCF-RN,MSN-rf]

Dear nelly8:  Radiation after lumpectomy reduces local recurrences by about 50%.  Before you make a decision about radiation be sure you speak to a radiation oncologist who can give you a more precise idea of how much lung and heart will actually be affected.  Most of the time this is minimal.

The chemo may indeed increase survival by only 3% but I would check about the hormone therapy.  This can not only prevent recurrence but it can also prevent a second primary breast cancer.  Most women tolerate it very well.

If you get a recurrence (locally - in the breast), a mastectomy can be done on irradiated tissue.  Reconstruction may represent a bigger challenge.  Chemotherapy would also be recommended.