I don’t want to have radiotherapy to my whole breast without understanding the rationale

Ask our Nurses your questions
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Due for radiotherapy in 3 weeks time. HER -ve HR +. Stage 2, T2, node -ve. Op was in December.

Is it usual to have radiotherapy to the whole breast with this diagnosis and to have Letrozole for 5 years?

I spoke to a breast care nurse who said that having the whole breast done is as good as having a mastectomy in terms of risk of recurrence.

If that’s the case, why will I need Letrozole also? Do women who have mastectomies have to take Letrozole because if they don’t then I’m wondering if it would be over treatment.

I was previously told that the radiotherapy was very precise and only to treat the area of the tumour. I don’t know what to make of all the conflicting information.

Also, in six months time, there may be an option for targeted therapy but at the moment it’s only available if you can’t do the breath hold.

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Hi, my understanding is that the radiotherapy is to reduce the risks of recurrence in that area by ‘mopping up’ any stray/dormant cancer cells whereas the Letrozole is to reduce the risk of distant recurrence ie in bones, liver etc. Letrozole reduces oestrogen which is what oestrogen positive cancer cells need to survive. Hope this helps. You’re at a similar stage to me. Just took my first Letrozole tablet today and starting 15 sessions of radiotherapy in 2 weeks.

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I was told that the majority of cases of recurrence are local and having radiotherapy to the whole breast reduces the rate of local recurrence by 50% and it goes on working in your body for up to 6 years for the same reasons that @pearl2 already mentioned . It’s effect is confined to the area that has been treated though .

The hormone blockers work systemically to reduce oestrogen in your whole body to prevent oestrogen fed cancers from growing anywhere and in some cases to shrink them prior to surgery . People who already have a secondary cancer are often taking them as well.

This pathway is routine after lumpectomy and women who have had mastectomy are usually prescribed hormone therapy as well but with either surgery it can depend on the reason you had it and what the findings were .

It’s good that you’re asking these questions - you have to sign a consent form before they can proceed with radiotherapy so they should explain it so that you can make an informed decision .

As regards hormone therapy you could speak to your BCN again and if you feel you need further information after the Nurses have replied you could try calling them on their helpline xx

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Well if it wasn’t for the fact that I had an email notification, I think this thread would have been lost to the ether.

Thank you both for your replies.

Several things don’t make sense and don’t seem to add up…

I was told by the breast care nurse that the radiotherapy would be targeted to the op site.

I was told by the radiographer that with my diagnosis, in other trusts, targeted radiotherapy is offered but that at the moment they can’t offer it in my area but probably will be offering it in 6 months time. However they do offer it to patients who can’t do the breath hold.

So they can do it but won’t at the moment but probably will in six months!

If that’s the case, can anyone link the evidence to support whole breast radiotherapy for my diagnosis because I’d like to evaluate it for myself.

Also, the evidence for taking Letrozole, is there a link to the evidence? Seemingly it’s the sensible option but there’s so much to understand and I’d rather be fully informed.

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Because mine was on the right I wasn’t required to do the breath hold and I don’t really know about targeted radiotherapy so can’t answer that. My cancer was very tiny so I suppose I could have been a candidate for that rather than whole breast but as I’d had a failed procedure where the marker clip fell away ( it’s still inside me ) I was a bit concerned about stray cells possibly having escaped anyway so I was happy to have it. Some people have been waiting a considerable time for radiotherapy . As regards the pros and cons of Letrozole ….. hormone therapy is one of the things people on this forum feel most strongly about . You could speak to your team about Predict 3 and ask them to run through it with you - that might be helpful . Xx

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Hello mynamefornow,

Thanks for your message. It’s understandable you want to know more about the rationale for the treatment recommended to you following surgery in December.

Treatment options for breast cancer are agreed by the multidisciplinary team, and based on evidence and guidelines. Treatment will vary depending on the individual situation considering different factors including, the type, size and grade and stage of someone’s breast cancer. A patient’s wishes should also always be considered.

It sounds like you have had breast conserving surgery for a primary breast cancer. Surgery is usually the main treatment for primary breast cancer. However, additional treatments may be offered following surgery to reduce the risk of the breast cancer coming back in either the breast or chest area, or other parts of the body.

When you have breast-conserving surgery, you’ll usually also have radiotherapy to the remaining breast tissue on that side. It uses high energy x-rays to target and destroy any cancer cells that may have been left in the breast or chest and surrounding area after surgery. As @pearl2 and @JoanneN say, this is to reduce the risk of local recurrence.

Some women are offered partial breast radiotherapy. This is when radiotherapy is given to the area of your breast or chest where the cancer was removed, rather than the whole breast area. Partial breast radiotherapy may be considered if the risk of the cancer coming back is low and you’re going to be taking hormone (endocrine) therapy for at least 5 years.

Before you start radiotherapy treatment, you have a planning session to identify the exact area to be treated and the most effective dose of radiation. This also helps to limit the amount of radiation to surrounding tissue.

You may be asked to hold your breath for a short period of time during your planning treatment if you are having radiotherapy to the left side. The breath hold technique can help protect the heart from being affected by radiotherapy given to the left side. Your therapeutic radiographer will tell you how and when to hold your breath. Not everyone having their left side treated will need, or be able to use, this method.

As your breast care nurse says, long-term survival is the same for breast-conserving surgery followed by radiotherapy, as for mastectomy. Occasionally, radiotherapy to the chest wall may also be recommended if someone has had a mastectomy for an invasive breast cancer.

You usually start radiotherapy 6 to 8 weeks after your surgery. As @JoanneN says, there are currently some treatment delays across the UK; this wait may be longer for newer techniques.

You mention you are HR +, which sounds like your breast cancer is an oestrogen receptor positive breast cancer. As @pearl2 and @JoanneN say, hormone therapy, such as letrozole, is treatment that lowers oestrogen levels. Some breast cancers use oestrogen in the body to help them to grow. These are known as oestrogen receptor positive or ER-positive breast cancers. Letrozole is usually given after surgery to reduce the risk of breast cancer coming back or spreading elsewhere in the body. It may also reduce the risk of a new breast cancer developing.

Hormone therapy is often given for 5 years but is some might take it for up to 10 years, depending on their individual situation. If someone is oestrogen receptor positive and has had mastectomy, they usually also have hormone treatment. This is because it reduces the risk of new breast cancer or a breast cancer occurring elsewhere in the body with this type of surgery as well.

We suggest talking to your treatment team about your concerns. You can also ask them to explain more about the benefits of radiotherapy and letrozole in your situation. Treatment options are discussed in line with the most up to date evidence and guidelines available at the time and to enable you to make an informed decision that you feel is right for you. This includes discussing the possible benefits and risks of different treatments. As @JoanneN says, an online tool called Predict may be used to help patients and clinicians see how different treatments for early invasive breast cancer might improve survival rates after surgery. Although @JoanneN mentions Predict 3, this is not yet endorsed in the UK, so health professionals are still currently using the Predict 2 version. Your breast cancer specialist can talk you through this.

You may be interested the range of free supportive services. They include face to face and online courses and events.

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