by Dr. Katie Deming, Radiation Oncologist
As a radiation oncologist, I believe knowledge is power and strive to empower my patients with the most up-to-date information. This guide, "The 5 Things You Need to Know Before Radiation for Breast Cancer," should help you feel more informed as you head into radiation treatment.
1 Don’t Listen to Horror Stories About Radiation.
You may be warned about the toll and discomfort you’ll endure during treatment. Fortunately, these are not reflective of modern radiation for breast cancer. A recent study showed that over half the women who received radiation for breast cancer had heard terrible stories from other people about radiation, and were frightened before starting treatment. However, only 2% said they agreed with the stories after their own treatment. Furthermore, most of them agreed with the statement: “If future patients knew the real truth about radiation therapy, they would be less scared about the treatment.” The side effects of radiation for breast cancer are usually limited to mild to moderate skin irritation/redness and mild fatigue. The best place to get accurate information about what to expect is from your doctor and care team. Chances are this treatment is going to be much easier than you expected.
2. One Size Does Not Fit All.
Radiation is customized to your cancer and is different for every woman. The type and duration of radiation recommended by your doctor will depend on your age, stage of cancer, and type of surgery. Radiation can be limited to part of the breast, the entire breast (or chest wall after mastectomy), and lymph nodes. Additionally, radiation can vary in the length of treatment, ranging from 1 week to 7 weeks. The most common length of radiation is 3-4 weeks. If you are having 5-7 weeks of treatment, it is likely because you have lymph nodes involved with cancer or underwent a mastectomy. Ask your doctor in order to understand the rationale for your radiation treatment plan.
3. Radiation After Lumpectomy vs Mastectomy.
You may hear from friends that their radiation was either a breeze or really hard. As you now know, radiation for breast cancer is not all the same. The skin reaction tends to be worse for radiation after a mastectomy than after a lumpectomy. After a mastectomy, the tissue at risk for cancer recurrence is directly below the skin, whereas it is usually a few centimeters below the skin after lumpectomy. In order to increase the dose to the area at risk, most women receiving radiation after a mastectomy will have something called bolus put on the skin for treatment (either daily or every other day). The bolus is a flabby jello-like material that is laid on top of the skin for treatment. The bolus helps build the dose up at the skin. Once your skin gets bright red, some radiation oncologists will remove the bolus. Other doctors will leave it on throughout treatment. Regardless, the skin reaction is expected to be worse for patients who have had a mastectomy.
4. Skin Creams Matter.
You may get recommendations from many people about which cream to use during radiation. For many years, there wasn’t any data to support the use of any specific cream. Thankfully, we now have data supporting the use of Calendula (derived from a flower) to prevent burning and peeling from radiation. Additionally, there is data suggesting a benefit to the use of Mometasone (steroid cream) for radiation after a mastectomy. Make sure to ask your doctor which cream he or she recommends for you.
5. Get Moving!
Studies show that exercising during radiation reduces fatigue related to treatment, and makes the radiation work better (lower chance of recurrence). Exercise does not need to be vigorous. Walking is sufficient to achieve this benefit. The goal is 150 minutes of exercise per week. You can break that up however you want, but a simple plan is 30 minutes, five days per week. If you’re not already exercising, gradually work your way up to 150 minutes. If you’re already engaged in an exercise program, there’s no need to back off or modify your routine unless you develop pain or discomfort.
So, there you have it! Radiation is easier than most women expect, especially with the help of creams and exercise.
Additional Topics About Radiation & Breast Cancer: