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 type of radiation that is used in x-rays, but the doses are higher and focused on the treatment area. Typically radiation happens daily for about 4-6 weeks and begins 4-8 weeks after chemotherapy or surgery. It takes approx 15 minutes after the patient is settled on the radiation table.

In order for radiation to be delivered with accuracy, patients must be perfectly aligned on the table day after day. In order to facilitate this, patients are typically tattooed in approximately 5 places on the upper body in order 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).

If your doctor feels it is safe for you to have a lumpectomy, radiation would be part of the standard protocol if you are under the age of 70.  With other types of surgery, radiation is advised in the following cases:

  • Stage 3
  • 4+ positive nodes
  • 1-3 positive nodes may require radiation after considering other tumor factors
  • tumors greater than 5 cm

Radiation and reconstruction: It is always best to consult with your radiation oncologist and plastic surgeon before having a mastectomy or immediate reconstructive surgery. Although this may be something that seems second to treating your cancer, it needs consideration at the time of surgery and diagnosis. Radiation can affect reconstruction in varying degrees from minor infection to major complications such as loss of implant or loss of flap.

There are two main types of reconstruction, implant based and autologous tissue transfer. Since it is difficult to expand skin and underlying muscle following radiation, many plastic surgeons prefer to get started on the reconstruction before radiation occurs. Results are much better when the skin is stretched over an expander or implant before radiation therapy begins. Please note that skin expanders and permanent implants can be radiated. There are, however, sometimes strong institutional preferences on this point and radiation is slightly better tolerated on tissue expanders and for delayed reconstruction.  Delayed reconstruction should not be attempted until one year after completion of radiation to ensure healthier skin and a successful reconstruction.

Beyond The Shock – Chapter 6 – Treatment – Radiation Therapy

Learn more about external and internal radiation, as well as the various side effects.

Breast Cancer Radiation: Will I Need Radiation?

Learn more about when radiation might be necessary to treat breast cancer, and the need to see a radiation oncologist before surgery.

What Is Hypofractionated Radiation Therapy?

Learn more about hypofractionated radiation.

next steps:

Welcome to the BTC Treatment Decision ToolHave you or someone you love recently received a diagnosis of breast cancer?

Whether you received a diagnosis yesterday or three months ago, you are likely dealing with an upheaval in your life as you’ve known it. Perhaps you have also started the process of meeting with your doctors to discuss what treatment options are available, and which therapies (or combination of therapies) will be the best for you. It is a lot of information to sort through and make sense of.

So we’re here to help.

The team at Be the Choice are a diverse group of women and men who have had experiences with a breast cancer diagnosis and treatment. Some of us have undergone treatment for breast cancer, some of us have provided care for a loved one who has been through treatment, and some of us are physicians and other health care professionals who provide treatment to breast cancer patients.

United in our concern that all people who receive a diagnosis of breast cancer should have access to comprehensive, state-of-the-art treatment information in a comfortable and user-friendly format, we designed this interactive treatment decision tool.

How to use:

Your diagnosis of breast cancer has come with an assessment of your unique clinical and hormonal characteristics. These should be carefully discussed with your medical team and deliberated carefully in advance of any treatment decisions.

This tool will enable you to get to know the “big picture” as well as the “individual picture” behind any breast cancer treatment decision, and to become an active participant in determining your own treatment process. You are the ultimate decision-maker in this process. We hope that you will use the information on this website to inform and empower yourself.

What this tool is not designed to do is deliver individual treatment recommendations. It should be used as a way to get a sense of the full range of treatments available to you as well as what your own treatment plan might look like given your unique profile.