Did you know there are many different types of breast cancer? Cancer types are determined by the protein expression profile of the cancer cells—for example, estrogen receptors (ER), progesterone receptors (PR), and a growth factor (HER2). Because there are different types of breast cancer, there are different ways to treat each patient. A cancer care team will work together to determine the best treatment option, which may include radiation therapy, and tailor a plan to each patient.
What is radiation therapy?
Radiation therapy is one treatment option for patients with cancer. High energy X-Rays are delivered into the target site. The patient experience is similar to getting a diagnostic x-ray, such as a chest x-ray, or CT scan. Radiation causes DNA damage that cannot be repaired by cancer cells. Normal/healthy cells can repair the damage and are relatively spared. Most cancer patients with most types of cancer are recommended to undergo some amount of radiation therapy as part of their treatment plan.
When the energy beam is delivered from outside the body, it is called external beam therapy. For some types of cancer treatments, a radioactive source is implanted inside the body, called brachytherapy.
What are some types of radiation therapy for breast cancer?
When it comes to treating breast cancer, radiation therapy is often a part of a patient’s care plan, because the therapy can be tailored to each person’s anatomy and cancer.
Before a patient starts radiation therapy, they will meet with a radiation oncologist to do a 3D model of their chest. Every patient has unique chest anatomy, and this allows the oncology team to create a customized treatment plan for each patient to preserve healthy tissue and minimize any impact to neighboring tissues, including organs such as the heart and lungs. This can also include determining if a patient needs whole breast radiation, partial breast radiation, and/or regional nodal irradiation.
Special considerations for left-side breast cancer patients
For patients diagnosed with breast cancer in their left breast, we want to be specifically aware of the proximity to the heart. There are a couple of ways we can decrease the amount of radiation reaching the heart.
Deep inspiration breath hold treatment
Imagine taking a deep breath and holding it for 20-30 seconds. When we do this, our lungs fill with air and create space between our chest wall and the internal organs. This extra space is what allows deep inspiration breath hold treatment to lower the amount of radiation reaching the heart.
This technique has dramatically lowered radiation exposure to the heart and should decrease the risk of cardiac injury.
Intensity modulated radiation therapy
To help protect the organs surrounding cancer cells, sometimes we use intensity modulated radiation therapy. With sophisticated technology, this technique creates energy beams that vary in intensity or strength. This better enables us to protect healthy tissues and organs while destroying cancer cells and can be used for treating a wide range of cancers (not just breast cancer).
When is radiation therapy used for breast cancer?
Radiation therapy is typically used in addition to surgery to control any microscopic cancer that might be left behind after surgery. That could mean after a lumpectomy, which removes a small amount of tissue, or after a mastectomy, which removes all of the breast tissue.
Radiation therapy after a lumpectomy would target more of the tissue that had surrounded the breast tumor and could use whole breast or partial breast radiation. Radiation after a mastectomy would target a larger area, especially if there were concerns or evidence of cancer spreading to nearby structures or lymph nodes. Radiation therapy can also be used for breast cancer that can’t be removed with surgery.
How long does radiation therapy take?
Radiation therapy generally takes 15 minutes each session, and most patients can expect to have therapy sessions five times a week for one to six weeks, in general. As with all other aspects of treating cancer, we tailor this time frame to the individual and what is needed to treat their cancer.
For some patients, particularly those with a low risk of breast cancer recurrence whose cancer is found early, we’ve adopted an accelerated partial breast radiation, also known as the Florence protocol. This practice combines a partial breast intensity modulated radiation therapy and a shorter time frame for a lower risk of damaging neighboring tissues, with equally low recurrence and survival rates.
We have also adopted the FAST-Forward protocol for some patients, which shortens the time frame to one or two weeks with whole breast radiation therapy.
While these treatment plans with shorter time frames are currently not suitable for all cancer patients, we do utilize these treatment strategies when we can as part of a patient’s personalized cancer treatment.
What are the side effects of radiation therapy?
Short-term side effects may include swelling in the breast near the targeted tissues, sunburn-like skin changes (redness, peeling, etc), and fatigue. These effects typically go away within a few months after treatment ends.
Longer-term side effects are mostly cosmetic and may include a reduction in breast size and long-term changes to the skin. Other typically less common side effects include discomfort in the treated region, rib fractures, radiation pneumonitis, suboptimal cosmesis of breast reconstruction, damage to the nerves in the arm, or lymphedema of the arm.
Many of these side effects are influenced by the location of the cancer cells. Your radiation oncologist will discuss any potential side effects of your personal radiation therapy plan in more detail and encourage you to ask any questions about the plan.
Treating breast cancer begins with finding it as soon as possible
Breast cancer research and treatment options have come a long way. At the Breast Cancer Center at Brown University Health, we are leading the way with early adoption of radiation technology and enrolling patients in clinical trials. We customize radiation treatments to benefit the patient, with a personalized approach to treating breast cancer. However, the best chance at treating breast cancer with the best possible outcomes depends on catching breast cancer as early as possible.
Routine mammogram screenings remain the best way to find breast cancer early, even before any physical changes in breast tissue may be noticed. Talk with your primary care provider about any family history of breast cancer or other risk factors. Newer guidelines recommend screening start at 40, with some variability in the frequency of screening. For more information on breast cancer treatment options, visit our website, and visit our Breast Imaging services page to schedule a mammogram in Rhode Island or Massachusetts.
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