Radiation or not

Just want to say that if tamoxifen doesn't work out, or you get a second opinion favoring aromatase inhibitors rather than tamoxifen, I did 5 years of letrozole with a baseline osteoporosis that was hardly mild. I was unable to take Reclast during my treatment due to another health condition.

None of my oncologists suggested tamoxifen despite my relatively severe DEXA scan, so I was interested to read your doc's recommendation.

My bone density did drop the first year of letrozole, similar to the first year of menopause, and then the rate of loss steadied. I am on Tymlos now and doing well, though I did end up fracturing 18 months ago due to an unwise movement (after cancer meds and before Tymlos).

I was actually going to comment today on radiation after lumpectomy, so glad you wrote your comment. I am 73 years old, generally healthy but have early Osteopenia. I was also diagnosed with ER+PR+ HR2-. My surgeon removed a 15mm lump and cleaned up a bit of old ductal calcification. The Oncologist advised Letrosole for 5-10 years (with possibility of multiple side effects). The Radiation Oncologist advised a short course (5day) of radiation. Because of my low OncoType (16) score combined with my age and early stage cancer, they felt that I should do one or the other, pills or radiation. I chose radiation. Finished my treatment Nov. 11. The treatment decision is very difficult. I feel that each doc believes in their particular path of expertise. I’ve read enough to know that the entire process is a number/percentile guesstimate. At my age, I want the best quality of life. I know the mortality rate is the same for most survivors with similar diagnosis. You may want to visit with other patients making their choices on treatment. I asked many friends and family members and had several revisits with both doctors. I prayed and made my decision. Best to you and blessings along the way.

Thank you windyshores, that’s helpful to know. My DEXA score was -2.5. Very mild it seems. Happy you are doing so well.

Thank you elliej. Although your tumor was much smaller than mine, I may ask the radiologist about a shorter dose of radiation. She said it would be 16 treatments over 3.5 weeks. They didn’t do an onco score because it wasn’t needed, and no lymph biopsy either. Instead a thorough ultrasound of the lymph nodes which looked normal. It seems there is a tendency to do less treatment rather than more.
Best of luck to you on your journey.

I was diagnosed with stage 1 invasive ductal cancer in September 2022. Tumor was 3 mm in size, only detected by mammogram. Had lumpectomy which healed well. Entire tumor was removed with biopsy as pathology on surgical sample showed no trace of cancer. No oncotype test done as told tumor was too small, only done on 5 mm and larger. No node involvement found. Now on Arimidex and so far no side effects. Meanwhile bone scan showed osteopenia worsening and would get osteoporosis soon even without estrogen blocker. So now on Fosamax for two years. Both radiology oncologist and regular oncologist said life expectancy same with or without radiation so opted out of it. It was a hard decision. I am 71 years old.

@gerarda -2.5 is borderline. Did you have an Oncotype test done?

You are so welcome. This site, Connect, has been so helpful to me on this scary journey. My treatment was at Mayo, Az. The 5 day course was such a blessing for us, as I live in NM and they got me in and out quickly. The entire dept was amazing. I didn’t have any lymph node involvement, stage 1.
Just consider all factors for your specific case. You will do whatever is best for You. Prayer is a great comfort in decision making. 😘🙏🏼

No, no oncotype test was done.
I was told I didn’t need chemo, therefore no oncotype test.

I am curious how docs knew no chem was needed without the Oncotype. I am sure there is a reason. It might help others to know.

My oncologist said since no lymph node involved, no chemo.