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Older Women May Be Able to Skip Radiation Treatment

Surgery and tamoxifen may suffice for small breast tumors in those over 70, studies show.

September 02, 2004|From the Baltimore Sun

BALTIMORE — After years of controversy over the best way to treat small breast tumors, researchers have found that thousands of older women can forgo radiation treatments without hurting their survival chances.

Two studies to be published today in the New England Journal of Medicine found that radiation does not provide any added benefit for women over 70 who receive lumpectomies and take the cancer-fighting drug tamoxifen.

"It suggests that upfront radiation is not necessary and may in fact be over-treatment for many of the older women," said Dr. Jerome Yates, vice president for research at the American Cancer Society, which was not connected to the study.

Radiation treatments are much safer than they once were but cost thousands of dollars and can produce unpleasant side effects including pain, swelling and skin discoloration.

Though the results might stir disagreement, researchers said, the studies could spur a major shift in the standard of care for tens of thousands of breast cancer patients each year. Almost 40% of the 200,000 women diagnosed annually are 70 or older, and most have relatively small breast tumors.

The findings are limited to lumpectomy patients whose tumors feed off the body's natural supply of estrogen -- tamoxifen works by inhibiting the hormone -- but that group represents the vast majority of women with the disease. A lumpectomy is the surgical removal of a tumor that leaves the breast largely intact.

Dr. Lauren Schnaper, a breast surgeon with Greater Baltimore Medical Center who participated in one of the studies, said the findings could be profound for older women in rural areas who live far from radiation centers.

Such women are often forced to undergo mastectomy -- total removal of the breast. Now, many of the women can feel reassured about skipping either radiation or mastectomy.

The studies focused on different groups but reached conclusions that many researchers viewed as complementary.

In a Canadian study, doctors assigned 769 lumpectomy patients to receive tamoxifen and radiation or tamoxifen alone. After five years, less than 1% of the patients who received radiation treatments had recurrences in the affected breast, compared with 7.7% of women who received the drug only.

Past age 60, however, the differences closed significantly -- and past 70, they all but disappeared. And across all groups, there was no difference in the chance of surviving five years.

In the second study, conducted at Massachusetts General Hospital and other cancer centers, doctors focused on women 70 and older who had tumors no larger than a centimeter in diameter. (The Canadian study included women with tumors of up to 2 centimeters.)

At five years, there was a slight difference in the chance of recurrence in the affected breast, 1% for those who received radiation and 4% for those who did not. But there was no difference in the five-year survival rate, about 86% in both groups.

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