Dr. MJ Bazos MD,
Therapy after Lumpectomy
What is a
Until a few years ago, women with breast cancer
almost always underwent a mastectomy (removal of the whole breast). Lumpectomy
(also called “breast-conserving surgery” [BCS] or “partial
mastectomy”) is a less radical operation that removes only the diseased
part of the breast and leaves healthy breast tissue in place. Studies have now
shown that women who have a lumpectomy followed by radiation treatment live just
as long as women who choose to have a mastectomy. Four out of 5 women with
breast cancer have tumours that are suitable for treatment with
What is radiation
Radiation therapy (also called
“radiotherapy”) is the use of high-energy x-rays to kill cancer
Do I need radiotherapy if I have a
Yes, radiotherapy is almost always recommended
after lumpectomy. Cancer can return in the same breast after surgery (local
recurrence), and it has been proved that radiation reduces this risk
significantly. Although there are no guarantees, the benefits of radiotherapy
are so great that you should definitely consider it as part of your
But my doctor says I have a low risk of
recurrence because I am over 50 years old and my tumour was very
It is true that your risk of recurrence is
relatively low. Still, about 1 in 5 women over 50 years old with small tumours
will have a recurrence within 8 years if they have a lumpectomy without
radiotherapy afterward. Radiotherapy can reduce that risk to about 1 in 50.
It’s an extra margin of safety.
Does radiotherapy have unpleasant side
Radiotherapy can have side effects that occur
both during and after the treatment. In the first weeks after beginning
radiation therapy, you may notice reddening or swelling of the skin over the
breast area and fatigue or tiredness. These problems usually disappear within 3
to 6 months. In the first 5 years after treatment, you may experience
discomfort, pain, swelling, discolouration or other skin changes in the breast
area. However, over 90% of women are satisfied with the appearance of the breast
after lumpectomy and radiation treatment. Some breast tissue may also shrink or
become hard due to the death of fat cells, especially in areas where high-dose
“boost” treatments were given. This hardening does not mean that the
cancer has come back. With current techniques, severe longterm side effects are
rare. Even in older studies, which used different techniques and higher doses of
radiation than would be recommended today, these problems occurred in under 2%
of patients treated.
Isn’t it true that radiation can
Any danger from radiation depends on the type of
radiation, how much is given and how it is applied. There is no convincing
evidence that the kind of radiation therapy given after lumpectomy can cause
cancer, either in the breast or elsewhere in the body.
I had tissue removed from one small area, but
my doctor wants to radiate the whole breast.
There is good evidence that radiation given to
the whole breast is more effective than partial irradiation in preventing a
What is a
Sometimes, as part of radiotherapy, an extra
dose (boost) of radiation is given to the small area where the cancer was
removed. Most often it is used when not all of the cancer was taken out during
lumpectomy. Normally, a second operation to remove any remaining cancer is the
best choice when this happens. But if this is not possible for some reason, or
if you decide not to have more surgery, a “boost” of radiation to
the area can be the “second-best” option. However, there is no clear
proof that a “boost” of radiation provides any benefit. Research is
under way to investigate this question.
What is the best way to give radiation
therapy? Is there a “right” dose of radiation?
Radiation treatment is not given all at once. It
is divided into “fractions” — small doses scheduled 5 days a
week that are given over 3 to 6 weeks. If “boosts” are given, they
are also divided into fractions. So far, no clinical trials have been completed
to show exactly which treatment schedule or dose is best. Evidence from existing
studies suggests that there are several different schedules that produce similar
benefits. Because all of these are acceptable, it may be possible to choose the
treatment program that best fits your personal schedule. However, it is
important to stay within a standard range. Unusually high doses can result in
more severe side effects without giving extra benefit.
Should radiation treatment begin right after
surgery? How long a delay is safe?
If you are not having chemotherapy, radiation
treatment should begin as soon as possible after your incision heals, usually
within 8 weeks after surgery. It is generally believed that radiation treatment
should not be delayed longer than 12 weeks after surgery, although there is no
proof to support this. If you are having chemotherapy, most cancer centres
recommend that radiation treatment be delayed until chemotherapy is finished.
Sometimes both kinds of treatment are given together. However, there is no
evidence that this improves the outcome, and it can increase the risk of
unwanted side effects, especially if any of the anthracycline drugs (drugs like
Adriamycin) are used as part of your chemotherapy.
Are there any situations where radiotherapy
should not be given after surgery?
Yes. Pregnant women and those who have had
previous high-dose radiotherapy to the chest (including radiation for
Hodgkin’s disease) definitely should not receive radiation therapy.
Radiotherapy may pose an increased risk for some people with severe heart or
lung disease. Also, people with scleroderma or systemic lupus erythematosus may
be at increased risk for severe side effects from radiotherapy. Some people with
certain conditions such as arthritis may be unable to lie flat or to stretch out
the arm on the same side as the breast being treated. In these instances it may
be difficult or impossible to give radiation treatments