Radiation oncology uses precisely focused beams of energy to eliminate cancer cells, and is a fundamental part of modern breast cancer treatment.
The main purpose of radiation to treat breast cancer is to reduce the chance the cancer comes back in the same area after surgery.
Radiation is an especially critical component of breast preservation therapy, which generally consists of lumpectomy, lymph node sampling and radiation oncology. This approach to treating breast cancer may be recommended as an alternative to mastectomy for women with small cancers relative to their breast size.
Radiation may also be used as an additional treatment for patients who have had a mastectomy to reduce the risk of cancer recurrence, or for patients who have breast cancer that has spread to other parts of the body.
If you have been diagnosed with breast cancer, here is what Nuvance Health radiation oncologists Dr. Philip Gilbo, chief of radiation oncology at Norwalk Hospital, and Dr. Camilo Torres at the Dyson Center for Cancer Care, want you to know about radiation therapy.
Does a radiation oncologist treat every breast cancer patient?
Dr. Gilbo: The breast cancer team is made up of physicians specializing in radiology, breast surgery, medical oncology and radiation oncology as well as many individuals in important support roles.
The vast majority of patients will have a direct consultation with a radiation oncologist. Occasionally, there are patients who do not need radiation oncology, but they will have had a radiation oncologist likely review their case at one of our multidisciplinary meetings.
Dr. Philip Gilbo, Chief of Radiation Oncology, Norwalk Hospital
What factors determine whether radiation therapy is recommended?
Dr. Gilbo: There are several factors that influence our recommendation for a patient to have radiation treatment. Radiation oncologists pay special attention to your breast cancer journey, including:
- Imaging studies, such as a diagnostic mammogram or breast biopsy
- Medical history and previous treatments you may have received
- The type of surgery you had to treat the breast cancer
- Pathology findings that indicate the type and stage of your breast cancer
- Genetic testing results
- Plans for systemic therapy (medical oncology)
Treatments are individualized and are also influenced by factors that are important to the patient.
Dr. Torres: Regarding pathology, we look for factors that may predict a local recurrence, such as tumor markers, that would require a patient to receive radiation treatment to reduce the risk of the cancer coming back.
The pathology of the tumor may also indicate that the cancer has a low-risk of recurring, which may influence the type of radiation therapy we recommend, if any at all. Other factors include age. Some patients, especially those over the age of 70, may have the option of not receiving radiation therapy.
Dr. Camilo Torres, Radiation Oncology, The Dyson Center for Cancer Care
When is radiation oncology recommended?
Dr. Torres: Radiation treatment is usually recommended to help prevent a recurrence of cancer in the same area for patients who had breast preservation surgery, such as lumpectomy, and have low-stage and low-grade cancer.
Systemic treatment — whole body — is usually given first under the direction of a medical oncologist followed by radiation oncology for patients who have high-grade cancer, aggressive cancer such as triple negative breast cancer or metastatic breast cancer that has spread to other parts of the body.
Dr. Gilbo: Regarding metastatic breast cancer, radiation can help remove cancer that has spread to other parts of the body. If eliminating the cancer is not possible, radiation may at least provide pain relief by shrinking the tumor, which may reduce or even eliminate the need for narcotics.
What should patients look for in a radiation oncology program?
Dr. Torres: If you have been diagnosed with breast cancer and need to make decisions about your care, look for an accredited cancer center with a multidisciplinary approach to treatment. The cancer center should include board-certified physicians, licensed physicists and therapists, and registered nurses, dietitians and other roles.
Dr. Gilbo: You should have confidence in your physicians and feel like they take time to answer your questions. Regarding a multidisciplinary approach, cancer medicine is a team sport. Look for a cancer center that has established programs and close relationships between specialists.
Also look for a cancer center that offers supportive services such as nutritional support, lymphedema therapy and survivorship programs, because they play an important role in recovery from breast cancer and help patients achieve optimal outcomes.
How long does radiation therapy take?
Dr. Gilbo: Patients often ask me about treatment logistics and the length of treatment. In general, most radiation treatments are scheduled daily, Monday through Friday. Total treatments can range from as few as five to up to 30 depending on the type of breast cancer. Most sessions take around 20 minutes, though often the total experience within the department may take up to an hour.
Does radiation therapy hurt?
Dr. Gilbo: The typical experience is that patients neither see nor feel the radiation; it is like getting an x-ray but with higher energies. The radiation is painless and non-invasive.
Does radiation therapy have side effects?
Dr. Gilbo: The most common side effects of radiation therapy are fatigue and skin reactions, which are managed by your radiation oncologist.
Dr. Torres: The fatigue is not all day long but only at certain times of the day and usually short-lived. The skin reaction varies; it could be as little as some redness of the skin or as severe as a sunburn. Side effects are more likely during the middle of the full treatment schedule. We see our patients every week and assess their side effects.
It is also important to note that patients are not radioactive when they receive external beam radiation. Some patients are concerned about their loved ones — especially their kids and grandkids — receiving radiation from their treatment. We assure our patients that there is no radiation taken with them when they leave the cancer center.
Is radiation therapy safe and effective?
Dr. Torres: We have more than 50 years of data and experience based on clinical trials showing that radiation therapy is safe and effective.
New technology allows us to deliver very concentrated and focused beam radiation that protects nearby organs by keeping the radiation away from them.
There is ample data that compares mastectomy with breast preservation therapy with radiation therapy. Studies show these treatments to be equally effective at stopping the growth of the cancer from its origin, a measurement known as “local control”.
The bottom line: Radiation is one of the main pillars of cancer treatment. Radiation treatments are individualized based on the type and stage of cancer, location, previous treatments and patient preferences. At Nuvance Health, patients receiving radiation therapy are supported all the way through their treatment from a team of cancer specialists and support services.