Radiation therapy in Breast Cancer – What, When and Why?
Medically reviewed by: Dr. Jay R. Anam
Topics covered in this Article:
Overview
Radiotherapy or Radiation therapy is a treatment modality used in breast cancer treatment as an adjuvant, to reduce the risk of recurrence of the disease. The basic principle of radiotherapy is the use of high-energy rays to destroy the cancer cells that may sometimes remain in the breast even after an optimal surgery for cancer. Radiation therapy has a role in all stages of breast cancer. Recent evidence has also suggested the possible role of Radiation as prophylaxis against breast cancer in some selected cases. Let us understand the intricacies.
Radiation therapy in Breast Cancer – What, When and Why
Treatment of breast cancer has evolved over more than a century. The Edwin Smith Surgical Papyrus, a medical text dating back to 3,000 – 2,500 BC, mentions breast cancer. Even Hippocrates had described the stages of breast cancer in 400 BC. William Halstead in 1882 had performed the first radical mastectomy in which not only the breast but underlying pectoralis muscle was surgically removed and axillary lymph nodal clearance was done. X-Ray was first discovered in the late 1890s and within a year of discovery, it was used in the treatment of breast cancer.
Presently, when it comes to surgery in breast cancer, we have come to a point where less is more. We have graduated from disfiguring radical mastectomies to breast conservation surgeries with aesthetic reconstructions.
This transformation from extensive tissue resection surgeries to aesthetic conservative procedures with minimal tissue loss has been possible only due to advances in adjuvant therapy, which includes radiation therapy, chemotherapy and hormonal therapy, which drastically reduces the risk of disease recurrence after optimal surgery.
Radiation therapy uses high energy X-Rays, Gamma rays, protons or electrons to treat the affected breast and is indicated in almost all patients of early breast cancer undergoing breast conservation surgery. In some selected patients, like older ladies with estrogen and progesterone receptors- strongly positive breast cancers, those with small tumours and no nodal spread, after careful consideration, radiation may be avoided.
All patients who receive pre-surgery chemotherapy, due to the size of the tumour or due to nodal involvement, need to undergo adjuvant (treatment after surgery) radiotherapy. All tumours more than five cm in size, or those causing skin ulceration over the breast tissue and those undergoing mastectomy will require adjuvant Radiation.
The EBCTCG Meta-analysis of 2011, which included over 10000 patients, showed a 50 % reduction in local recurrence of disease over ten years and also a 4% reduction in death due to breast cancer in those who received adjuvant Radiation (1).
Radiotherapy works by damaging the DNA of the cancer cells, thus killing them. The damage is either by direct ionisation or indirect ionisation of the DNA material of the cancer cells. Charged particles like protons can cause direct damage to the DNA material. Photons like X-rays usually cause indirect ionisation due to the formation of free radicals which in turn damage the DNA structure beyond repair and hence cause cell death. The unit of Radiation is Grays(Gy). Depending upon the intent of treatment and site of treatment, the dosage varies. Dosage for breast cancer is 45 to 55 Grays, administered in small daily fractions. Conventional Breast Radiotherapy includes 1.8 to 2 Gy per fraction for five days a week, over five weeks to complete 50 Gy dose for breast cancer.
This Fractionation of radiotherapy over so many days is crucial as it gives time for the normal healthy cells, which also get affected, to recover from the harmful effects of the radiation. Tumour cells are unable to recover. Fractionation also allows the tumour cells that have been in a relatively resistant phase of the cell cycle into a radiation-sensitive G2- M phase before the next dose of Radiation.
Fractionation also gives time for the tumour cells to reoxygenate, which makes them more vulnerable to the damaging effects of radiation, as oxygen is the primary source of free radicals which damage the tumour cell DNA. As Fractionation is such an important component, any modification can impact the outcome.
With this basic understanding, trials have targeted this dose and duration of Radiation to come up with the most effective combination.
In this day and age of instant food and instant cricket, there has been a constant attempt towards reducing the duration of Radiation.
What if we could adequately radiate the tumour bed, intra-operatively, when it is most accessible? This form of radiotherapy too has been tried. After the excision of the tumour, a special kind of portable radiotherapy machine is brought in the surgical field in the operation theatre to precisely radiate the tumour bed and surrounding areas.
This form of Radiation, where only a part of the breast is irradiated over a short period, is called Accelerated Partial breast radiation(ABPI). The Target A (Targeted intraoperative radiation therapy- A) trial with 3451 patients and the ELIOT (External versus Intraoperative radiation therapy) trial with 1305 patients concluded that this form of one-time radiation therapy during the surgery is associated with higher local recurrence rates(2,3).
Let’s Fight Like A Girl!
Intraoperative radiation therapy
The tumor recurrences are even more with high-grade tumors and triple-negative breast cancers. Hence presently this type of intraoperative radiation therapy is not recommended outside trial settings. Another application of ABPI is Brachytherapy.
Brachytherapy catheters in place
Brachytherapy is suitable for patients of breast cancer who are more than 50 years of age with a tumor size of 3 cms or less, grade 1 or 2, estrogen and progesterone receptor- strongly positive, Her 2 neu receptor-negative and node-negative. At the time of surgery, multiple hollow catheters are placed in the surgical field/tumor bed after the tumor resection. Through a special radiotherapy machine, Radiation is delivered to the tumor bed through these hollow tubes. With this method, radiotherapy is over in five days instead of the five weeks that are needed with conventional radiotherapy(4). the five-day schedule has been a blessing.
Radiation therapy planning
Radiation is associated with acute toxicities that involve the treated area skin, muscle and internal organs. These complications are relatively uncommon. Long term complications include lung injury, cardiotoxicity and secondary malignancy. With the improvements in radiotherapy planning and techniques, these long term side effects have been significantly reduced.
The fundamental principle of using radiation therapy in the adjuvant (after surgery for breast cancer) setting is that it reduces the risk of local recurrence. So, extending this logic, it could be assumed that radiation can prevent cancer in patients at high risk of developing breast cancer.
This hypothesis was put to the test by radiation oncologists in Israel. All BRCA mutation patients undergoing treatment for breast cancer were offered prophylactic radiotherapy to the opposite healthy breast. 81 patients opted for Radiation, whereas the other 81 patients opted for just surveillance and hence were enlisted as controls.
At a median follow up of 58 months, 10 patients from the control group had developed cancer on the contralateral normal breast, while only 2 patients who had received prophylactic Radiation developed cancer. These results are encouraging; however, a longer follow up is required to include this treatment in practising guidelines. At present, for a patient with BRCA gene mutation, who are at higher risk of developing breast cancer in the opposite healthy breast, a prophylactic mastectomy with reconstruction is recommended.
Radiation is also a beneficial palliative modality. In patients with stage IV breast cancer, having bone metastases, single-dose radiation of up to 10 Gy can reduce the bone pain, which is otherwise often unresponsive to any analgesics.
Recently in very specialised centres, radiotherapy treatment using proton beam is available. This modality allows for precise targeting of the tumour bed with minimal collateral damage. For breast cancer, this treatment is still in the investigative stage and available only in a trial setting.
Thus, modern cancer treatment is a very sophisticated and advanced science offering the cutting edge of technology from different fields of medicine to help all those who are battling this Emperor of maladies. Radiotherapy, along with Chemotherapy and Surgery is one of the three major pillars of modern cancer care. Radiotherapy has made a huge positive impact to the outcome and extent of surgery for breast cancer. Gone are the days where breast cancer universally meant a disfiguring and life changing mastectomy. Today, with huge advances in the science of radiotherapy, breast conserving surgery has become the new normal. Things have never looked so bright for breast cancer patients, as it is now.
Appointment Form
About Author
Dr. Jay Rashmi Anam
Surgical Oncologists
15+
Year Of Experience
MMC- 2006031309 (2006)
Dr. Jay Anam is one of the best surgical oncologists & breast cancer specialist in Mumbai.
Dr. Jay Anam has Completed his M.Ch. Surgical Oncology training from Tata Memorial Centre. He did his Fellowship in Breast Oncology from Centre Oscar Lambret, Lille, France.
As a breast cancer specialist, he believes in world-class cancer care for all patients.
Let’s Fight Like A Girl!
Latest Blogs
Mammography vs Ultrasound: Which is Best for Breast Cancer?
Home| BlogsMammography vs Ultrasound: Which is Best for Breast Cancer?Receiving a recommendation for breast imaging can be a stressful and confusing experience. You might be wondering why your doctor suggested a specific test, or what the difference is between the...
Can Breast Cancer Cause Back Pain?
Home| BlogsCan Breast Cancer Cause Back Pain? Back pain is an extremely common problem that can affect anyone, regardless of age. It often results from everyday activities like sitting incorrectly, lifting heavy objects, or a simple muscle strain. But have you ever...
Can You Get Breast Cancer During Pregnancy?
Home| BlogsCan You Get Breast Cancer During Pregnancy?Yes, it is possible to get breast cancer during pregnancy. Pregnancy brings many changes to the breasts—lumps, tenderness, and swelling—which can make spotting cancer difficult. This guide explains...
Facing breast cancer surgery is a brave step, and we know the recovery process may feel overwhelming at times. One aspect of recovery many patients encounter is managing surgical drains.
While these medical devices play a crucial role in your healing, they can be intimidating at first. But don’t worry. With the right knowledge and tools, you can manage them confidently and focus on feeling better.
This guide is here to walk patients and caregivers through every step of drain care—from the basics to troubleshooting to emotional support. By the end, you'll feel prepared to tackle this part of your recovery with ease.
Author
Dr. Jay Anam
Breast Cancer Surgeon and Oncoplasty specialist in Mumbai
Introduction
Why are surgical drains important after breast cancer surgery? These small, plastic tubes help remove excess fluids that can build up in your body as you heal. Getting rid of this fluid reduces swelling, prevents complications like infections, and helps your body recover faster.
We’ll cover everything you need to know, including how to empty and clean your drains, spot signs of infection, manage discomfort, and return to daily life with confidence.
Understanding Surgical Drains
To start, it’s helpful to understand what surgical drains are and why they’re used.
What Are Surgical Drains and Why Are They Necessary?
After surgery, your body produces fluid as part of its natural healing process. Sometimes, this fluid needs help draining so it won’t pool under the skin. That's where surgical drains come in.
Types of Drains
There are a few kinds of surgical drains commonly used:
- Jackson-Pratt (JP) drain – Often shaped like a small bulb, this popular option collects fluid that you can measure and empty.
- Hemovac drain – A slightly larger round container, often used for higher drainage needs.
Your surgeon will determine the best type for you based on your surgery.
How Long Will They Stay in Place?
The timeline varies. Most patients have their drains for 7 to 14 days, but it depends on how much fluid they produce. Don’t worry; your doctor will remove them once output slows down.
Step-by-Step Drain Care Guide
Drain care is manageable if broken down into steps. Let's cover the essentials.
How to Empty the Drain Properly
- Wash your hands thoroughly with soap before touching the drain.
- Unplug the bulb or container, holding it upright.
- Carefully pour the fluid into a measuring cup.
- Record the amount and time in a log to share with your doctor.
- Squeeze the bulb to reset the suction before plugging it back in.
💡 Tip: Empty the drains 2-3 times a day, or whenever they’re about half full.
Cleaning & Infection Prevention
- Gently clean around the drain site with soap and water or antibacterial wipes. Avoid tugging or rubbing the area.
- Watch for signs of infection, such as:
- Redness or swelling around the site
- Fever above 100.4°F
- Foul odor or colored drainage
If you notice these, call your doctor.
Best Sleeping Positions
Finding a comfortable position can be tricky. Try:
- Sleeping on your back with pillows under your arms for support.
- If you’re a side sleeper, place a small cushion around the drains for padding and avoid putting pressure on them.
💡 Tip: A drain-friendly post-surgery pillow with built-in pockets can make rest easier.
Showering & Hygiene Tips
Ask your surgeon if showers are allowed. If so:
- Cover your drains with a waterproof dressing or use a surgical drain belt.
- Limit water exposure to avoid infections.
If showering isn’t an option, stick to sponge baths until your doctor gives the green light.
Recognizing and Managing Complications
Sometimes, issues arise. Here’s what to keep an eye on:
When to Call Your Doctor
- Drainage suddenly increases or stops altogether
- Severe pain or swelling
- Fever or signs of infection
Dealing with a Clogged Drain
A frequent issue is a clogged drain. If you notice reduced suction:
- Milk the tube by gently squeezing it to dislodge the blockage.
- If this doesn’t help, notify your healthcare provider promptly.
Signs of Seroma (Fluid Buildup)
Once drains are removed, some patients develop a seroma. Symptoms include swelling, tenderness, or a feeling of liquid under the skin. While many seromas go away on their own, consult your doctor for advice.
Pain & Discomfort Management
-
Pain is part of recovery, but you don’t have to suffer unnecessarily.
Medication vs. Non-Drug Relief
- Use prescribed painkillers as directed.
- Non-medical options, like a cold compress or heating pad (with your doctor’s approval), can help with aches and stiffness.
Gentle Exercises
Simple arm stretches or shoulder rolls can prevent tightness, but avoid anything strenuous. A physical therapist can provide guidance.
Relaxation Techniques
Practice deep breathing or try mindfulness exercises to cope with discomfort.
Diet & Nutrition for Faster Healing
Fueling your body helps tissues heal faster. Focus on:
- Protein-rich foods, like lean meats, tofu, beans, and eggs.
- Anti-inflammatory options, like berries, leafy greens, and nuts.
- Drink plenty of water every day.
- Consider supplements, like zinc or vitamin C, but check with your doctor first.
Physical Activity & Movement Guidelines
Movement helps, but balance is key:
- Begin with light stretches or short walks to prevent stiffness.
- Avoid lifting anything heavier than a few pounds in the first week.
- Your doctor will guide you on when you can resume driving or house chores.
💡 Tip: Use a supportive bra to minimize any strain during recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.