Some good news for older women with early stage breast cancer: they can safely skip radiation if they undergo a lumpectomy and begin medications.
New research, to be presented at a meeting of the American Society of Clinical Oncology, suggests that older women who take tamoxifen after their diagnosis live just as long as those who also undergo radiation.
The finding could save many women from the pain and exhaustion that often follows radiation therapy, as well as save the health care system from unnecessary costs.
Researchers led by Dr. Kevin Hughes, co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital in Boston, studied 636 women over the age of 70 who had small breast tumours that were estrogen-positive and node-negative -- the most common kind of breast cancer in women in this age group.
All the women underwent a lumpectomy, a form of surgery in which the tumour is removed but the rest of the breast left intact.
Half the women got radiation treatment and then took tamoxifen for five years. Tamoxifen is a powerful medication that has been shown to cut in half the risk of breast cancer recurrence. The other half went straight to tamoxifen.
After more than 10 years, the women who underwent radiation and tamoxifen had a 2 per cent chance of breast cancer recurrence, compared with an 8 per cent chance of recurrence among those who received tamoxifen alone. But the two groups didn't differ significantly in terms of overall survival.
In fact, among the women who died during the study period, more than 95 per cent died from something other than breast cancer.
"We did find that radiation did have some benefits in terms of in-breast recurrences but those benefits are relatively small," Hughes told reporters Friday.
Hughes said the low cancer recurrence rates in the women who skipped the radiation was noticed early in the study, but there were worries that as the study went on, more recurrence cases would be found, leading to more deaths. In fact, that did not happen.
"This study confirms that for older women with early stage breast cancer, lumpectomy without radiation is a viable alternative, and tamoxifen may replace the need for radiation."
ASCO president Dr. Douglas Blayney said many physicians have already begun recommending that radiation be skipped in older women. He said this study confirms that "this is a reasonable course of action."
The full study is to be presented at the annual meeting of the American Society of Clinical Oncology, June 4 to 8 in Chicago.
