By Michael Russell
Most breast cancer patients wonder why radiation is necessary if a breast cancer has been removed. Despite local removal of the cancer tissue, about 30% of women will have a relapse without radiotherapy. Pathologists often have difficulty determining if there is a clear margin of normal tissue surrounding the cancer, given the difficulty of measuring of minuscule amounts of cancer cells. It is also known that there may be “skip” areas between the cancer tissue and small hard-to-detect satellite cancer nodules in the immediate vicinity. Thus, in spite of clear margins, cancer cells may be resting on the other side of the biopsy margins. Cells may have migrated through the breast duct system and come to rest outside of the biopsy site as well. Radiotherapy is important because it has a good chance of destroying those random cancer cells beyond the breast cancer margins.
The method of radiotherapy involves the use of a machine called linear accelerator, which converts radioactive particles into a high-energy radiation beam that is used to treat a specific, defined area of the body. Radiation affects cells in the area of the tissue beneath the directed beam of radioactive particles and dividing cells are affected more by radiation than resting, non-cancerous cells. Cancer cells are, therefore, more affected than healthy cells, but both cell types are damaged by radiation. On the other hand, normal cells have a greater ability to repair themselves following radiation exposure, compared to cancer cells. Radiation places cancer cells into a cell death cycle at the time of the next scheduled cell division. This cell death cycle is known as apoptosis.
Radiation delivered to the chest area is sometimes also recommended following breast resection (mastectomy) if the cancer extended to or through the surgical margins or if the cancer has spread to the lymph nodes. The addition of radiotherapy in these situations reduces recurrence risk considerably.
So is radiation always necessary? If it were easy to pick 60 to 70 percent of women who would not have a local recurrence, then radiotherapy could be optional in most cases. Unfortunately, this is not so easy to do. If the cancer is small, with a large clear margin of non-cancerous tissue and if there is no local spread to the lymphatic system, then one might consider observation alone and no radiation may be necessary, especially if the woman’s breast has a large amount of fat tissue. As a woman ages, the ratio of fat tissue to glandular tissue increases. It is quite normal for the female breast to contain significant amounts of fat, which is not necessarily related to obesity. In fact, thin women can have breasts that contain a large percentage of fat. Thus, the fat content of the breasts may be a factor in considering the need for radiotherapy after mastectomy.
There are adverse effects from radiation to the breast. It is usual to have some skin changes, which will manifest as redness and some inflammation that usually heals over time. 90% of women have an excellent cosmetic result once healing is visible. 10% have some fibrous tissue formation, shrinkage of the breast and a reduction in skin elasticity and sensitivity in the breast area. There are several treatments that can be used on the breast skin to facilitate healing and reduce the long-term effects of radiation.
Michael Russell Your Independent guide to Breast Cancer
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