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Opting out of radiation or chemo
Has anyone ever had a lumpectomy but opted out of radiation therapy or chemotherapy? Does anyone have statistics on the recurrence rate if one chooses not to do one or both?
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Can’t say I haven’t considered it but as I seem to be near side effect free I’ll continue and look forward to some rigorous studies on this.
Had my DEXA declined … ?
I’m always searching the research on any meds. This is the only med I take or have ever taken on a daily basis.
Could you point me to those studies on other AI s?
@anjalima Well, here is one with exemestane (I omitted some of the technical details), but another with Letrozole from some time ago I am trying to 'refind' (lost in my files!). I wrote a Dr who did a similar study (not yet published) with the same AI and he thought results would be similar for Arimidex, although arimidex is different from exemestane, a steroidal. Again, not all might agree with this...
On other issue, I know a woman with early stage bc who is in a clinical trial here in Canada to test whether 2 yrs on an AI is as good as 5 yrs...food for thought!
JAMA Oncol
. 2023 Mar 23;e230089. doi: 10.1001/jamaoncol.2023.0089. Online ahead of print.
Efficacy of Alternative Dose Regimens of Exemestane in Postmenopausal Women With Stage 0 to II Estrogen Receptor-Positive Breast Cancer: A Randomized Clinical Trial
Davide Serrano et al
PMID: 36951827 PMCID: PMC10037202 (available on 2024-03-23) DOI: 10.1001/jamaoncol.2023.0089
Abstract
Importance: Successful therapeutic cancer prevention requires definition of the minimal effective dose. Aromatase inhibitors decrease breast cancer incidence in high-risk women, but use in prevention and compliance in adjuvant settings are hampered by adverse events.
Objective: To compare the noninferiority percentage change of estradiol in postmenopausal women with estrogen receptor-positive breast cancer given exemestane, 25 mg, 3 times weekly or once weekly vs a standard daily dose with a noninferiority margin of -6%.
Design, setting, and participants: This multicenter, presurgical, double-blind phase 2b randomized clinical trial evaluated 2 alternative dosing schedules of exemestane. Postmenopausal women with estrogen receptor-positive breast cancer who were candidates for breast surgery were screened from February 1, 2017, to August 31, 2019. Blood samples were collected at baseline and final visit; tissue biomarker changes were assessed from diagnostic biopsy and surgical specimen. Biomarkers were measured in different laboratories between April 2020 and December 2021.
Interventions: Exemestane, 25 mg, once daily, 3 times weekly, or once weekly for 4 to 6 weeks before surgery.
Results: A total of 180 women were randomized into 1 of the 3 arms; median (IQR) age was 66 (60-71) years, 63 (60-69) years, and 65 (61-70) years in the once-daily, 3-times-weekly, and once-weekly arms, respectively. ... Sex hormone-binding globulin and high-density lipoprotein cholesterol had a better profile among participants in the 3-times-weekly arm compared with once-daily arm. Adverse events were similar in all arms.
Conclusions and relevance: In this randomized clinical trial, exemestane, 25 mg, given 3 times weekly in compliant patients was noninferior to the once-daily dosage in decreasing serum estradiol. This new schedule should be further studied in prevention studies and in women who do not tolerate the daily dose in the adjuvant setting.
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1 Reaction@anjalima OK, here's the Letrozole one:
Double-blind, Randomized Trial of Alternative Letrozole Dosing Regimens in Postmenopausal Women with Increased Breast Cancer Risk
Cancer Prev Res (Phila). 2016 February ; 9(2): 142–148. doi:10.1158/1940-6207.CAPR-15-0322.
Ana Maria López et al
Abstract
Aromatase inhibitors (AIs) profoundly suppress estrogen levels in postmenopausal women and are effective in breast cancer prevention among high-risk postmenopausal women. Unfortunately, AI treatment is associated with undesirable side effects that limit patient acceptance for primary prevention of breast cancer. A double-blind, randomized trial was conducted to determine whether low and intermittent doses of letrozole can achieve effective estrogen suppression with a more favorable side effect profile. Overall, 112 postmenopausal women at increased risk for breast cancer were randomized to receive letrozole at 2.5 mg once daily (QD, standard dose arm), 2.5 mg every Monday, Wednesday, and Friday (Q-MWF), 1.0 mg Q-MWF or 0.25 mg Q-MWF for 24 weeks. Primary endpoint was suppression in serum estradiol levels at the end of letrozole intervention. Secondary endpoints included changes in serum estrone, testosterone, C-telopeptide (marker of bone resorption), lipid profile and quality of life measures (QoL) following treatment. Significant estrogen suppression was observed in all dose arms with an average of 75 – 78% and 86 – 93% reduction in serum estradiol and estrone levels, respectively. There were no differences among dose arms with respect to changes in C-telopeptide levels, lipid profile, adverse events (AEs) or QoL measures. We conclude that low and intermittent doses of letrozole are not inferior to standard dose in estrogen suppression and resulted in a similar side effect profile compared to standard dose. Further studies are needed to determine the feasibility of selecting an effective AI dosing schedule with better tolerability.
Thank you! Interesting!
You can purchase from ComfortSlings.com or Amazon.com. Best of luck!
You have to think you are free of the cancer. Our thoughts play a big part in our illness. I had a radical mastectomy when I was 36. No radiation, chemo or follow-up medication. I had the second breast removed two year later because of fibrosis (no cancer). My husband went to Mass every morning for one year and prayed for my recovery. That was 56 years ago. I am now 92. No recurrences, and I cannot say it was because of all the additional treatments. I believe God has a plan for us, and we will not leave this earth, until he decides it is our time. So put on your best Pant Suit or Dress, get your hair done, go to dinner with your favorite fellow and remember how good life was before all this cancer entered your life. LIFE IS STILL GOOD, embrace it as never before. You have a long life ahead of you, do not waste it on painful thoughts. It is probably more likely for you to have a car accident then a recurrence, do you think about that every day? I think not. You have so much to give to others, do it now.
Gina5009
Gina5009
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4 ReactionsSince I didn’t have reconstruction, I wonder how they can do the MRI. Normally one would lay flat on her stomach with the breast hanging into a hollow depression. Would it be done the same way if I have no reconstructed breasts?
I’m not entirely sure but I think it’s worth an ask. My reconstruction boob hangs down but the MRI sees the chest wall and nodal environment but also sees my healthy breast. so I’m thinking maybe a traditional MRI might work for you … but I would ask about it.
Read comments in feed “ distant recurrent risk”. There is a very recent post there by a woman who has bilateral mastectomy without reconstruction who received breast MRI’s for ongoing detection.
IMO Worth looking into… and insisting upon!