Patients having had a lumpectomy for DCIS or Pleomorphic LCIS require post-operative radiation on the whole breast to decrease local recurrence.
Local recurrence means that the DCIS or Pleomorphic LCIS has come back in the breast either as another DCIS or Pleomorphic LCIS or an invasive cancer.
Patients having had mastectomy with or without reconstruction do not require radiation.
Radiation is a localized cancer treatment that works by damaging DNA to kill cancer cells and shrink tumors. Unlike chemotherapy, radiation is not a systemic therapy since it does not act on the whole body. The delivery of radiation mimics receiving an x-ray and is not felt by the body. The most common form of radiation (photon) is the same as that used in x-rays, but the doses are higher and focused on the treatment area. Typically radiation happens daily for about 4 to 6 weeks and begins 4 to 8 weeks after chemotherapy or surgery. It takes approx 15 minutes after the patient is settled on the radiation table.
For radiation to be delivered accurately, patients must be perfectly aligned on the table day after day. For breast radiation the patient may be placed in either the supine (on your back) or prone (on your belly) position. To facilitate the best placement, patients are typically tattooed in approximately 5 places on the upper body to align them. Tattoos are placed at the time of your treatment planning. They are typically blueish/grayish and about the size of a small freckle. For those patients who have strong objections to permanent tattoos, non-permanent options exist and can be discussed with your medical team beforehand.
Immediate side effects of breast radiation include skin irritation. This might feel like a sun burn with skin turning red or brown, breast tenderness and/or swelling. Some patients feel tired. Most side effects are worse at the end of the radiation treatments. Within six months you might get a cough that may be accompanied by a fever called radiation pneumonitis. This is rare but the signs are important to recognize and to know that it’s not bronchitis or a cold. It is very important to see your radiation oncologist right away if this develops.
Longer term side effects of radiation include increased density of breast tissue and discoloration of the skin. There is a very small risk of rib fracture and extremely small risk (1 in 500) that radiation may lead to the development of other cancers decades later. There may be a very small risk of heart disease if your cancer is on the left hand side.
If reconstruction is desired, it is always best to consult with your radiation oncologist and plastic surgeon before having your surgery of choice. Although this may be something that seems second to treating DCIS, it needs consideration at the time of surgery and diagnosis. For more information on the types of reconstruction.