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Radiation Therapy Concerns, Risks and Benefits

Radiation therapy is an important part of treatment for many breast cancer patients. It is very effective in prevention of breast cancer recurrence; however, there are many myths about radiation therapy that deter people from considering it.

What is Radiation Therapy?

Radiation therapy uses high energy beams of radiation directed at tumors or the site where a tumor has been removed from to kill cancer cells that are present.[1] Radiation targets the cell’s DNA causing mutations and ultimately, failure of DNA replication. When a cell can no longer replicate, it dies and the cellular material is removed by the immune system and recycled within the body.

Radiation therapy can be given in several ways. The most common type is external beam radiation, where the beam must travel through the skin to reach the site to be irradiated. Another type is internal radiation or brachytherapy. This type uses small radioactive seeds that are inserted either into a device or directly into the body. These seeds emit radiation for a defined amount of time and affect the tissue directly surrounding it with minimal scatter.[2]

When Will I Have Radiation Therapy?

Radiation therapy can be used at different times during the treatment of breast cancer. The following are examples of when it may be used.

Radiation and Lumpectomy – Radiation therapy is part of breast conserving therapy. It is defined as lumpectomy followed by radiation therapy, to prevent recurrence of the cancer locally. This is typically done for Stage 0 to Stage I breast cancer. During the lumpectomy, the surgeon removes the cancer in the breast and may or may not sample a few of the axillary lymph nodes for cancer. After the surgical wound has healed, radiation therapy is begun and typically lasts for five to seven weeks. If the breast cancer recurs, the only option is to remove the breast with a mastectomy, since the same area cannot be irradiated twice.

Radiation Alone or Prior to Surgery – Radiation can be given as a sole form of palliation, not treatment, if the cancer has invaded into the chest wall and/or has spread all over the body. In this scenario, the goal is to shrink the tumor and keep it from causing symptoms. Radiation therapy can also be given prior to surgery to shrink a tumor that would not be able to be removed with surgery otherwise. Sometimes, radiation can shrink the tumor just enough to be able to remove it surgically. This is rare in the treatment of breast cancer and more common in others, such as lung cancer.

Myths Surrounding Radiation Therapy

People have heard many horror stories and myths about radiation therapy that can be a deterrent to a very effective and useful treatment. The following are a few examples:

  • ‘I do not want to have radiation because it will hurt’ – There is minimal pain associated with the treatment itself. There may be some soreness in the skin a few weeks after treatment has begun and may last for the duration of treatment.
  • ‘I am afraid I will become radioactive’ – With external beam radiation no radioactive material enters the body. You will not be exposing others to radiation after your treatment. With internal radiation, you are only ‘radioactive’ while the seeds are in place and for a short duration after. Your doctor will discuss how long you need to avoid being around others, especially children, if this is the case.
  • ‘I do not want to lose my hair when I have radiation’ – Chemotherapy for breast cancer causes you to lose your hair. Radiation therapy to your breast or axilla does not cause you to lose your hair.
  • ‘I am worried about being nauseated or vomiting’ – Again, nausea and vomiting are a side effect of chemotherapy, not radiation.
  • ‘Will radiation give me cancer again?’ – While it is true that radiation exposure does have a role in causing certain types of cancer, it is important to note that there are different types of radiation. Cancer-causing radiation is typically from UV, or ultraviolet light. The kind of radiation used most often in treatment of cancer is that from high energy photons that are from substances such as cobalt or cesium. These high energy photons are passed through a linear accelerator and aimed directly at a tumor, causing damage to cancer cells.

Risks and Benefits

Benefits

  • Kills cancer cells that may have been left behind after surgery, prevent recurrence of cancer
  • Noninvasive – external beam radiation therapy
  • Minimally invasive – internal radiation therapy
  • Out-patient visits
  • Painless during the procedure for external beam radiation, minimal pain involved with internal radiation
  • Highly effective at preventing recurrence

Risks

  • Skin irritation and redness
  • Fatigue
  • Weakening of skin at the site
  • Potentially permanent skin discoloration at the site

The most common side effects of radiation therapy are to the skin. The area being treated may become red or appear to be sunburned. It may also be itchy, numb, dry, sore or develop an ulcer. But most of these side effects are temporary and can be relieved with simple treatments.

Do the benefits of radiation therapy outweigh the risks? Research shows that radiation therapy reduces the risk of breast cancer recurrence by up to 60%. That alone is the greatest benefit of radiation therapy. If you are a candidate for radiation therapy, discuss any other concerns you may have with your doctor and together you can decide if it is right for you.

References

1  External Beam Radiation Therapy. (n.d.). Retrieved from National Cancer Institute: www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page3

2  Internal Radiation Therapy. (n.d.). Retrieved from National Cancer Institute: www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page4

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.