Breast cancer is a malignant disease estimated to affect more than 245,000 women every year in the U.S. alone. The disease, which can also afflict men, is the result of an uncontrollable growth of cells in the breast. Improvements in diagnosis have increased the number of cases caught before symptoms appear, which may include a new breast lump or mass, swelling of all or part of a breast, skin irritation or dimpling, breast or nipple pain, nipple retraction, nipple discharge other than breast milk, and redness, scaliness, or thickening of the nipple or breast skin.
The American Cancer Society estimates that about 40,450 women in the U.S. will die from breast cancer this year. However, there are numerous treatment options for people with the disease. Local treatments are meant to treat the cancer locally, without affecting the rest of the body, and include surgery and radiation therapy. Systemic treatments, such as chemotherapy, hormone therapy, targeted therapy, and bone-directed therapy, use drugs that are able to reach cancer cells anywhere in the body and destroy the cancer.
Radiation Therapy for Breast Cancer Patients
Radiation therapy is a type of treatment that uses high-energy rays or particles to kill cancer cells. It may be used before or after surgery, or as primary treatment alone. There are two main types of radiation therapy for breast cancer: external beam radiation, which, as it sounds, is administered externally, and brachytherapy, which refers to radiation therapy internally administered. External beam radiation is the most common type of radiation therapy for breast cancer, with the radiation focused by a machine placed outside the body on the area affected by the disease. Physicians will define the extent of radiation needed based on the surgery performed, and if the lymph nodes were affected or not.
Breast cancer radiation therapy is usually given five days a week for about five or six weeks, but in the case of accelerated breast irradiation, larger daily doses are given for about three weeks. A slightly different technique, 3D-conformal radiotherapy, requires the use of a special machine but increases precision and reduces the damage to healthy tissue. Brachytherapy or internal radiation consists of placing a device containing radioactive seeds or pellets directly into breast tissue affected by the cancer. It can be used along with external beam radiation in patients who underwent breast-conserving surgery, or can be used alone. Different types of brachytherapy include interstitial brachytherapy, during which radioactive pellets are introduced by catheters into the affected breast area and remain in place for several days, and intracavitary brachytherapy, in which a device is placed into the space created by the cancer surgery and remains there for the duration of treatment.
Benefits and Risks of Radiation Therapy
The American Cancer Society demonstrates the effectiveness of radiation therapy in killing cancer cells and increasing the success of breast cancer surgery in curing the disease. However, the society also advocates for the choice of treatment. “One study that compared outcomes between intracavitary brachytherapy and whole breast radiation after BCS [breast conserving surgery] found that women treated with brachytherapy were twice as likely to go on to get a mastectomy of the treated breast (most likely because cancer was found again in that breast). The overall risk was still low, however, with about 4% of the women in the brachytherapy group needing mastectomy versus only 2% of the women in the whole breast radiation group,” stated the ACS.
“This study raises questions about whether irradiating only the area around the cancer will reduce the chances of the cancer coming back as much as giving radiation to the whole breast. More studies comparing the 2 approaches are needed to see if brachytherapy should be used instead of whole breast radiation.”
Like any other treatment, there are risks and potential side effects in radiation therapy. In the case of external beam radiation, the main short-term effects include swelling and heaviness in the breast, skin changes in the treated area, and fatigue. Some patients may notice that their breasts are slightly smaller, which can affect later breast reconstruction. Rarer occurrences include damage to the arm nerves (brachial plexopathy), lymphedema (if treatment includes axillary lymph nodes), weakened ribs and rib fracture, or, in very rare instances, angiosarcoma. In the case of brachytherapy, potential side effects include redness, bruising, breast pain, infection, a breakdown of an area of fat tissue in the breast, as well as rib weakness and fracture.
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