Two radiation experts share what you need to know.
There’s no doubt that getting a breast cancer diagnosis can be an incredibly scary experience. But, luckily, treatments have come a long way — and this includes one of the most common ones: Radiation therapy.
Also known as radiotherapy, it harnesses high-energy particles or waves — such as X-rays or electron beams — to pinpoint cancerous cells and prevent them from multiplying. It can even be delivered in different ways, whether externally through a machine or internally through a special needle or catheter (also known as Brachytherapy).
“Radiation’s like a firecracker: You light it up and then you don’t see anything and then suddenly, ‘boom’ and then it’s gone,” Janice Kim, MD, told Katie Couric Media in September 2023.
When radiation is used after surgery to remove cancer, it has been shown to significantly reduce the risk of your cancer coming back by about 50 percent (assuming that the disease hasn’t already spread to other parts of your body). Despite its effectiveness, radiation alone comes with a whole host of dangerous side effects — both short-term and long-term.
For some expertise, we turned to Dr. Kim and fellow radiation oncologist, Robert Mutter, MD, to break down what radiation therapy is and how it impacts the body.
How radiation for breast cancer works
Radiation therapy kills cancer cells by destroying the genetic material that causes them to rapidly grow and divide. But Dr. Kim said this is a delicate balance, given that both healthy and cancerous cells are damaged in the process of this treatment. Even though normal cells can repair much of the damage caused by radiation, the goal is to destroy as few healthy cells and cause as little harm as possible.
Thankfully, breast cancer happens to be very sensitive to radiation, so not much is needed to control the disease or stop it in its tracks. “Radiation is very effective at treating cancer cells, which typically divide quicker, whereas normal tissues are affected to a much lesser degree,” said Dr. Mutter in 2023. “So we’re able to give a relatively modest dose of radiation after surgery to reduce the risk of breast cancer recurrence.”
Why radiation is used
One of the upsides of using radiation is that it can be used to treat breast cancer at almost every stage. It’s most often used in conjunction with surgery, chemotherapy, and other medicines to prevent breast cancer from coming back. And for incurable cases – such as when the cancer has spread to other parts of the body — it’s commonly used to ease symptoms.
But, unlike other forms of treatment, radiation is generally localized, meaning it’s usually aimed at only the part of the body that needs therapy. In many cases, patients might just need radiation to a part of the breast — or partial-breast irradiation — where internal or external radiation is directed toward the area around where the cancer was removed.
Radiation side effects
Dr. Kim said these localized treatments can also help keep symptoms at bay, particularly when it comes to sensitivities around the treated area. For instance, many women develop a skin irritation resembling a sunburn that’s caused by the high exposure to X-rays. “Instead of treating the whole breast and getting a full sunburn, you might just develop a mini one or maybe nothing at all because it’s such a focused area,” she told us.
On top of various skin irritations, common reactions may also include mild to moderate fatigue and swelling in the breast. To help alleviate some of these unavoidable reactions, Dr. Kim likes to recommend homeopathic skin care products. Dr. Mutter, on the other hand, prefers to give his patients a cover that resembles saran wrap to prevent rubbing in the treated area and reduce the risk of further skin inflammation.
Radiation’s link to secondary diseases and cancers
Radiation therapy may increase a person’s risk of developing a different type of cancer years or may even decades after the fact. Though rare, some women may just be genetically predisposed to radiation-induced cancers. That said, Dr. Mutter said the risk of radiation-induced cancers for most breast cancer patients over their lifetime is “only a fraction of a percent.”
Unfortunately, due to its proximity to the heart, secondary cancers aren’t the only thing breast cancer survivors have to worry about; radiation also makes them more likely to develop cardiovascular-related diseases that can lead to cardiac arrest and heart failure. Thanks to advancements in technology and more awareness of the potentially toxic side effects of radiation, Dr. Kim told us that these deaths can largely be avoided nowadays.
How radiation can affect breast implants
Due to its damaging effects on tissues, radiation can make cosmetic procedures more challenging. For instance, radiation can cause asymmetry (a breast that has undergone reconstruction tends to sit higher up on the chest after treatment). That’s because radiation can cause the skin over an implant or tissue flap to become firmer and more rigid, which can also lead to infection and cause the breast that underwent surgery to leak fluids. But, don’t worry, there is a fix — a plastic surgeon may do a fat injection to help soften and improve the affected breast.
Still, these post-reconstruction risks can be mitigated with the right amount of radiation. Radiation is typically administered in small doses over several weeks, but Dr. Mutter said some studies show the benefits of giving bigger rounds each day and finishing over a shorter time. The thought behind this approach is that it reduces the risk of complications down the line.
“There’s a lot for us to still learn about why some patients might develop side effects where others may not,” Dr. Mutter said. But both doctors acknowledge that there’s still room for improvements to be made for breast cancer survivors.
“We’re not only worried about cancer recurrence and survival — but we also have to prioritize their quality of life and cosmetic outcome, because we don’t want women to look at their breasts and always be reminded of this diagnosis and be upset by it,” Dr. Kim said. “I’d rather her forget about it: That’s a success in my book.”
