Breast Cancer Radiation: Will I Need Radiation?

We teach you about the indications for, and benefits of breast radiation after a lumpectomy or mastectomy. Learn about the criteria to possibly avoid radiation after a lumpectomy.

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Questions for your Surgeon and Radiation Oncologist:

Will I need radiation if I have a lumpectomy?
Will I need radiation if I have a mastectomy?
How can I avoid radiation for my cancer?


Will I need radiation if I have a lumpectomy?

The answer is most likely, YES. For those diagnosed with a small, Early-Stage breast cancer, a lumpectomy followed by radiation is just as effective at curing your cancer as a mastectomy without radiation. Whenever the term “lumpectomy” is mentioned, it is assumed that “radiation” will follow the surgery in order to keep the chance of a breast cancer local recurrence to an acceptably low rate. There are some instances where a lumpectomy without radiation may be an option for those with very favorable breast cancers. Review our lesson on “Breast Cancer Recurrence” to learn about the threat to your life from “local and regional recurrence.”

Why is radiation often needed after surgery?

Quite simply, radiation reduces the chance of cancer growing back in the area where the tumor was surgically removed. When a lumpectomy is performed, the surgeon removes a normal layer of breast tissue around the cancer, called margins. Even if the margins are “clear” and uninvolved with cancer, there is still a small chance cancer cells can be left behind in that area of the breast. In the future, these cells can grow to become a “local recurrence” of cancer in the same area of the surgery. Without radiation, the chance of local recurrence after a lumpectomy is about 15 to 25% over a period of 10 years. Radiation reduces this risk to about 5 to 8%.

Will I need radiation after a mastectomy?

The answer is most likely, no. Post Mastectomy Radiation Therapy (PMRT) is the term for applying radiation to the area of the chest wall after a mastectomy, usually performed about 4 weeks after surgery or after both surgery and chemotherapy are completed. PMRT is generally recommended for those with a high risk of local recurrence.

If you or your surgeon. before surgery, think you might need PMRT it is essential to see your radiation oncologist before you have mastectomy surgery. This way, your radiation oncologist will better understand the size, shape, and extent of your breast tumor before it is removed by surgery or has shrunk away with neoadjuvant chemotherapy. Radiation oncologists have a unique insight into breast cancer treatment options that can assist your surgeon in planning the direction of your cancer care.

The decision to undergo Post Mastectomy Radiation Therapy is complicated. Patients should insist on a multidisciplinary team approach to get the best treatment recommendations for high risk breast cancer situations. When your breast surgeon works closely with your radiation oncologist and medical oncologist, you will be offered the best treatment options. Below is a general outline to help you understand when radiation after a mastectomy is needed.

How can I avoid radiation for my cancer?

Your surgical choice: Lumpectomy vs Mastectomy:

Lumpectomy with radiation is just as effective as a mastectomy without radiation for most early stage breast cancers. This is a choice made with your breast surgeon and is obviously a difficult one. The decision is also a personal one. Usually, you can avoid radiation if a mastectomy is performed for favorable cancers. Review our lesson on "Lumpectomy vs. Mastectomy" to learn the questions to ask your surgeon to be better informed about the risk and benefits of each surgical approach.

Advanced age or poor health:

If you are older than 70 and have a favorable, small tumor with no lymph nodes involved, you can consider having a lumpectomy and withholding radiation. This approach is only possible when you take a 5 to 10-year course of hormonal therapy. There are specific criteria for this “lumpectomy only” approach. Make sure to ask your radiation oncologist about the risks and benefits of radiation and no radiation in this situation. The same approach can apply if someone is more advanced in age or those with a fragile health status. In these situations, the risks of radiation can sometime outweigh the benefits of post-lumpectomy radiation.

Neoadjuvant Chemotherapy:

Chemotherapy before surgery for well selected patients can sometimes destroy all of the cancer cells in the breast and the lymph nodes. When surgery reveals that the tissue has no residual cancer cells after completing chemotherapy, this is called a Pathologic Complete Response (pCR).