Would you consider radiation omission for a patient with a Stage I breast cancer with an elevated Oncotype Dx?

I would offer the patient treatment based on the fact that she is in her 60s with a presumably long life expectancy, a high grade lesion, and radiation will lower her risk of local recurrence significantly. Even with a lower Oncotype, radiation will lower the risk of recurrence significantly according to multiple randomized studies. For more favorable cancers in older women, observation was something that was always an appealing option compared to 6 weeks of external beam radiation, which was fo...

If a patient can get a screening mammogram, a diagnostic mammogram, a wire/seed guided localization, a segmental mastectomy +/- SLN bx, consideration of chemotherapy, consideration of 5+ years of ET, why would a 5-day course of whole breast RT/APBI that reduces recurrence by 60-80+% depending on the study be debated?

I absolutely would not only offer RT, but recommend it. RT has always been shown to markedly decrease IBTRs. In 2024, the toxicity is near nil with APBI and just slightly higher tha...