Be assured that I checked with all my doctors and there was absolutely no barrier, financial or otherwise, to my decision ( not saying this cannot happen but it does not apply to me). I had a unilateral mastectomy with reconstruction.

If you familiarize yourself with phase III of clinical trial TAILOR RT, ( ongoing right now) you will understand this new possible protocol shift in the thinking of the medical community regarding radiation. It’s being administered by Radiation Oncology departments in major health establishments; I interviewed for the clinical trial at MSK for example.

Both my breast surgeons recommended AI only but suggested I have a conversation with ROnco… which I did… the standard fraction protocol was recommended… 5 days x 5 weeks. But the character of my BC suggested that radiation may not be necessary based on the TAILOR RT trial requirement. Bottom line; the rad oncologist who recommended the standard protocol called me up, was excited about my participation in a clinical trial, wished me well and “ hoped” I was randomized into the AI only group as she knew I preferred that course.

Ultimately I was eliminated for a reason not related to my BC characteristics…

Believe me, I was offered EVERYTHING! No barrier to any treatment I would choose. They will even reconstruct the healthy breast if I wanted that. All legally mandated through the ACA that Obama Sugned into law. It’s an extraordinary opportunity for women right now.

Thank you for your concerns. Blessings🌸

I had the same exact same thoughts....that not recommending radiation for breast cancer for older women was, essentially, writing them off or some 'economic triage' thing as recommended by policy advisers (Ezekiel Emmanuel and Cass Sunstein opinions come to mind).

And there might well be an element of that but both oncologists I saw noted that the NCCN revised guidelines were very specifically aimed at 'low risk' cancers that have better treatment options. And the NCCN guidelines still recommend radiation for older women with breast cancer for other kinds, and stages and grades, of cancer.

And the NCCN guidelines don't suggest an oncologist not recommend radiation even in low-stage ER+ small tumors. They just revised the guidelines to suggest that radiation no longer be automatically, or dogmatically, recommended in all of these cases as had been the previous policy.

I'm sure that the economics of health care for older patients (and maybe especially women as I didn't see a 'softening' of prostate cancer recommendations) continue to be a hot issue but am thinking that the NCCN guidelines are aimed at better medical decisions which aim to prevent rigorous over-treatment and overlook not-uncommon toxic side effects therefrom.

And there's some encouragement in the medical establishments increasing respect for the human body's own propensity to heal if not sledge-hammered by medical protocols that are proving to be effective at lower, gentler levels in some cases.

At least that's my thought after an early skepticism about possibly 'writing off' the elderly. I have an economics background and read much of the arguments 'against the too-expensive to treat' arguments that, in my jaundiced opinion, border on sanctioned elder abuse. But I think the NCCN policies are defensible as just better medicine?