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?