All IBC patients will require radiation therapy after their simple mastectomy.

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 does not hurt. It feels much like receiving an x-ray. 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. To facilitate this, 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 or discolor to 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 lymph nodes are being treated simultaneously, additional risks include lymphedema and brachial plexopathy (damage to the nerves which is extremely rare).