Questions for your Radiation Oncologist and Breast Surgeon:
- What are the risks and benefits of radiation?
- What different radiation options do I have?
- Can you explain what I should expect during and after radiation?
- What are the long-term side effects?
- How can I avoid radiation altogether?
What is Breast Radiation? What is a “Local Recurrence?”
Radiation therapy is very effective at killing cancer cells while sparing the normal surrounding tissue. This is only one component of a comprehensive treatment plan. Breast radiation is generally performed after your tumor has been surgically removed. If you are going to have a lumpectomy surgery to remove your breast cancer, then you will most likely need radiation to reduce the chance cancer will grow back in the surgical area. This is the most common use of radiation therapy for breast cancer.
Quite simply, radiation reduces the risk of “local recurrence” in the area where the tumor was surgically removed or in nearby areas where the cancer is at risk for recurring in the future. When a “local recurrence” of your cancer does occur, it is a threat to your life. When indicated, radiation reduces this risk of local recurrence, and as a result, may increase your chance of surviving breast cancer. Review our video lesson on “Breast Cancer Recurrence“ to learn more.
Is “Whole Breast Radiation” the standard of care?
Breast radiation is most commonly offered to women who undergo a breast conserving lumpectomy for early stage breast cancer. “Whole Breast Radiation” is the most utilized and researched form of radiation after a lumpectomy and is generally considered the “standard of care.” Another term used for the same treatment is whole breast “external beam radiation therapy.” For many women older than 50 with favorable early stage cancer, a cutting-edge, “shorter course” of whole breast radiation can be administered over 4 weeks rather than 6 weeks. Ask your radiation oncologist if you qualify for a “shorter, 4-week course” of radiation for your breast cancer situation.
We outline below some other techniques of delivering radiation for breast cancer. They all have distinct advantages and disadvantages. Take our video lesson on “Will I Need Radiation“ (here) to better engage your breast specialists.
General Radiation Treatment Expectations:
Breast radiation is usually performed as an outpatient procedure within a dedicated radiation center. Depending on the patient and the course of treatment, it is generally well tolerated. A few facts about radiation therapy are listed below.
Expectations during whole breast radiation
- The actual treatment takes about 15 minutes (although you will be at the appointment a little bit longer than that to change clothes before and after your treatment)
- Radiation does not hurt when administered
- Treatments are daily, Monday through Friday for about 4 to 6 weeks
- You can work while undergoing radiation treatment
Truths about Radiation:
Radiation therapy is a much more intensive form of radiation than what is used in routine X-rays, CT scans, and other radiologic tests. Radiation therapy is also confused with “chemotherapy” by many patients. Radiation therapy has a different set of side effects than chemotherapy.
Some truths about radiation
- Breast radiation does not make you feel ill
- There is no hair loss with radiation to the breast
- You will not become “radioactive” from treatment
Side Effects of Radiation Therapy:
The field of radiation therapy has dramatically reduced its side effects over the last decade. CT Scan Radiation Planning has revolutionized the ability to better focus radiation on the area of cancer and avoid damaging adjacent normal tissue.
Some side effects and toxicities
- Your breast and skin can become irritated and tender
- Some constricting or shrinkage of the treated breast and surrounding tissue may occur
- Breast reconstruction and implants can be affected
- General fatigue is common
- Your breast and ribs can be sore for an extended period of time
- You cannot have radiation if you are pregnant
- There is a small risk of increasing coronary heart disease
- There are very rare cancers that can be caused by breast radiation
Other types of breast radiation:
This shorter course (1 week) of radiation is applied directly to the area of surgery using devices made for this purpose. The results are promising for women over 50 years old with favorable tumors that undergo a lumpectomy. It is a form of accelerated partial breast irradiation (APBI). Not everyone is a candidate for brachytherapy. Review our video lesson on “Breast Brachytherapy“ to learn more.
3D Conformal External Beam Radiation Therapy
This form of accelerated breast irradiation uses 3-dimensional CT imaging to focus radiation to only the area near the lumpectomy without placing a device into the breast. The same equipment for whole breast radiation is used, but this focused approach can be completed within a week. A small number of radiation centers have embraced this approach.
Intra-Operative Radiation Therapy
Intra-Operative Radiation Therapy (IORT) is an evolving form of radiation therapy available at some hospitals. It is currently appropriate for only a small proportion of patients with early stage breast cancer. The benefit is that the radiation is administered and completed during the lumpectomy surgery in the operating room. It is a form of accelerated partial breast irradiation (APBI). The short-term and long-term results have yet to show the same effectiveness as whole breast radiation. Review our video lesson on “Intraoperative Radiation” to see if you are a candidate.
Post-Mastectomy Radiation Therapy
Post-mastectomy radiation therapy is the term for applying radiation to the area of the mastectomy and lymph nodes, usually performed about 4 weeks after surgery. It is generally recommended for those who are at a high risk to have a local recurrence of their cancer. Review our video lesson on “What is Radiation” to learn more.
Palliative Radiation Therapy
Palliative radiation is used to treat the symptoms of cancer growing in the breast or within other parts of the body. An example is someone who has severe back pain and leg weakness from breast cancer in their spine. Palliative radiation to the spine can help alleviate these symptoms.
Proton Radiation Therapy
This radiation approach is more commonly used for other types of cancer. Unfortunately, there are no large clinical trials that demonstrate that proton therapy for breast cancer is as effective as standard radiation therapy. Proton radiation for breast cancer must currently be considered “investigational.” There are about a dozen proton therapy centers in the United States.
This 10-minute video (here) explains what radiation does, when it is used, and the side effects that can occur. It is provided by the American Society of Radiation Oncologists, the leading radiation therapy organization. It is the best overview available about radiation for breast cancer.
This patient information sheet (here) is a good description and overview about radiation, although it is not not specific to breast cancer. The Journal of the American Medical Association is affiliated with the American Medical Association.
This link (here) by the American Society of Breast Surgeons has an excellent explanation of “Radiotherapy for Breast Cancer.” This site is created for patients by the American Society of Breast Surgeons.
This link (here) “When is radiation appropriate?” outlines when radiation is needed and not needed for breast cancer. This non-profit organization provides excellent patient resources about breast cancer.
This link (here) by the American Society of Breast Surgeons has an excellent description about “Post-Mastectomy Radiation Therapy.” This site is created for patients by the American Society of Breast Surgeons.
More Detailed References:
This free, interactive document (here) provides expert consensus recommendations for radiation for all stages and types of breast cancer. This webpage has a “dropdown menu” where you can select “Breast Cancer” under “guidelines” and find your clinical situation listed below. It is designed for breast specialists. The “User Guide” (here) shows you how to navigate these treatment recommendations.
If you want to get deep into the details, this free 200-page pdf document (here) has guidelines to help clinicians to make treatment recommendations about nearly all aspects of breast cancer. You can easily register (here) as a non-professional to get access and more information about breast cancer. The National Comprehensive Cancer Network is the leading organization in developing clinical guidelines.