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Experts say radiation therapy may not be needed for some women over the age of 65 with breast cancer. NoSystem images/Getty Images
  • Researchers say using radiation therapy on women 65 and older with a specific type of breast cancer may not improve their rate of survival.
  • They say this age group with hormone receptor-positive early breast cancer may want to carefully consider whether to have radiation and endure the treatment’s side effects.
  • Experts say the benefits and downsides of radiation therapy are different for every person, so the decision should be made carefully.

Some women 65 and over might not benefit from radiation therapy for a specific type of breast cancer, according to a recent study published in the New England Journal of Medicine.

Researchers from the University of Edinburgh found that for women over 65, foregoing radiation therapy for hormone receptor-positive early breast cancer did not change survival rates.

Radiation therapy typically follows surgery, is generally well-tolerated, and reduces the risk of recurrence.

Researchers reported that most trials for radiation therapy did not include participants over the age of 65, even though this group accounts for more than half of breast cancer diagnoses.

The researchers set out to design a clinical trial to determine whether the treatment benefited this population.

The study included 1,326 women 65 and over. All the participants:

  • Had tumors 3 centimeters or less and were hormone-receptor-positive.
  • Had surgery to remove the tumor.

One-half of the participants received radiation therapy as part of their treatment, and the other half did not. All received endocrine therapy for five years.

Endocrine therapy is a hormonal treatment that reduces the risk of recurrence in people with hormone-positive tumors. Side effects of endocrine therapy include menopause-like symptoms, nausea, and weight gain.

The researchers reported that the survival rate for both groups of participants was 80%, indicating that radiation did not impact survival.

Most women who died during the study period did not do so from breast cancer.

Long-term data from a 2020 study showed similar results for women over 70.

People with breast cancer face the decision of whether to forego radiation.

Deciding not to have radiation therapy isn’t the right decision for everyone.

“Older patients enrolled in this trial had several features that do not apply to everyone,” said Dr. Robert Wollman, a radiation oncologist and medical director of the Vasek Polak Radiation Oncology Department at Providence Saint John’s Health Center and an assistant professor of radiation oncology at the Saint John’s Cancer Institute in California.

These features included:

  • Breast tumors that were less than 3 centimeters.
  • Lymph nodes that were negative
  • Having to take an endocrine therapy pill for five years

“I would only recommend skipping radiation for patients who fit these parameters and are comfortable taking endocrine therapy for five years,” Wollman told Healthline. “The results do not apply to larger, node-positive, estrogen receptor-negative, and higher-grade tumors.”

Deciding to skip radiation therapy means committing to endocrine therapy for five years, as this treatment lowers the recurrence risk.

“One of the concerns with patients not receiving radiotherapy is that there is a high rate of noncompliance with endocrine therapy,” said Dr, Joseph Panoff, a radiation oncologist with Miami Cancer Institute, part of Baptist Health South Florida, “Then these patients are at higher risk of recurrence than the 9 percent quoted in the study. I believe partial breast radiation (if the patient is a good candidate) is a great way to split the middle and treat the patient.”

“Patients must understand that there is a higher recurrence risk while overall survival remains the same,” Panoff told Healthline. “I also explain that if they are not compliant with endocrine therapy, then this recurrence risk may be even higher, so endocrine therapy compliance is crucial.”

“It is important for a patient who is considering foregoing radiation to meet with her radiation oncologists to understand the associated risks and benefits fully,” said Dr, Tommy Sheu, the medical director at the Fred A Jordan Family Radiation Oncology Center at the Providence St. Jude Medical Center in California.

He said some questions to ask a radiation oncologist include the following:

  • How often and how long will radiation therapy take?
  • What should I expect after each treatment and therapy?
  • What are short and long-term side effects?
  • Is there anything I can do to minimize the side effects?
  • How soon can I resume my daily activities, including returning to work?

“When presented with a choice, some patients have adopted a more minimalist approach, while others want to do all they can to reduce the risk of local recurrence as much as possible,” Sheu told Healthline. “Some patients who know they are at a higher risk of recurrence may harbor more anxiety, particularly when awaiting results from screening mammograms or surveillance visits with their doctors. Such a patient may ultimately decide that reducing risk from 9.5 percent to 0.9 percent is worth radiation’s inconveniences and potential side effects.”

Recurrence means additional medical care. Procedures, such as biopsies, lumpectomies, and mastectomies, could be needed. Tolerance for this medical care should be factored into whether to forego radiation.

Other health conditions, fitness, and overall well-being all play a role in determining the best treatment.

“I cannot emphasize enough the importance of considering more than just a patient’s chronologic age when making a treatment recommendation,” said Dr. Wesley Talcott, a radiation oncologist at Lenox Hill Hospital in New York. “The assessment of the patient’s physiologic age (which includes their comorbidities and performance status), goals of care, risk-tolerance, willingness, and ability to undergo other adjuvant therapies (including five years of endocrine therapy) must all be considered. This allows the physician and patient to work together to identify the best patient-centered treatment plan.”

Radiation therapy kills cancer cells, but it can also kill healthy cells, according to the National Cancer Institute.

Radiation treatment has been around for more than 100 years, according to the American Cancer Society. During that time, medical advancements continue to improve the efficacy and safety of the treatment.

“Radiation has become increasingly more precise while sparing more organs at risk and normal tissue,” Panoff said.

Fatigue is commonly a side effect of radiation therapy, according to the National Cancer Institute. Other side effects are dependent on where you receive the radiation.

For breast cancer, the side effects include:

  • Fatigue
  • Hair loss
  • Skin changes
  • Swelling
  • Tenderness

Different types of radiation therapy exist, but external beam radiation therapy is often used for breast cancer. This treatment involves a beam of radiation aimed at a part of your body. The radiation lasts only a moment.

“Modern radiation therapy for women with early-stage breast cancer with lower-risk disease characteristics (the population included in this trial) is safe and well-tolerated,” Talcott said “The balance has shifted over the past decades to shorter, more targeted therapy and improved management of toxicities that do emerge. For example, using modern technology and trial data, it is common to treat the partial breast now or complete the entire radiation course in only five treatments. In contrast, previously, 25 or more treatments to the whole breast were standard. The known benefit of adjuvant radiation therapy I present to patients in our discussions has not changed, but the advancements have made radiation more accessible and tolerable to many women.”