Expert: Claes-Gustaf Nordquist, M.D. - 10/23/2009

Question
At age 85, my mother had a lumpectomy and used Tamoxifin for two years.  She has now been diagnosed again with Infiltrating Intraductal Breast Cancer in the same area.  Her treatment options are lumpectomy with six weeks of radiation or a simple mastectomy.  She is relatively healthy and active for her age but does have congestive heart disease and is tired most of the time.  My sister and I are not certain that six weeks of daily radiation is viable for her.  What are your recommendations.

Answer
Well, I fail to see why the radiation therapy would be so difficult. Which breast are we discussing? Was not radiation therapy given the first time? If not why? In my opinion doing a lumpectomy and not giving postsurgical radiation therapy is malpractice unless it is due to the fact that the patient refuses radiation.  Why was tamoxifen only given for 2 years. Normal treatment time is 5 years. Radiation therapy would be given daily 5 days per week for 6 weeks. Each daily treatment would take only a few minutes and if done correctly with not much side effects. I am myself a specialist in both medical oncology and radiation therapy. In the summer of 2008 it was found that I had a prostate cancer. I refused surgery (big risk of impotence and - much more important - risk of urine incontinence) and selected instead 2 months of radiation therapy. I received full therapy (in my old work place - I'm retired) with very little side effects. My PSA has gone down from 8.8 to 0.05 so I have good hope of being cured. Everything else is in good order. Even a simple mastectomy is a much bigger surgical operation than a lumpectomy. If she has heart problems surgery is probably a greater concern than radiation therapy. If she was my mother I would definitely recommend the radiation therapy. Besides if she had received radiation therapy after the first lumpectomy she would probably now be without cancer!
Good luck whatever your choice may be!