Radiation on Left Breast?

flyjune

My main question:

For those of you who had breast cancer in the left breast and went forward with radiation, can you tell me how you came to that decision? It would also be great to know how long ago it was, if you have had any complications, and if you were considered young to be getting BC. Thanks!

Some context:

I'm having surgery this week. I've gone back and forth when trying to decide between lumpectomy + radiation and a bilateral mastectomy. The concern I have about radiation is the risk to my heart and lungs. Studies estimate heart disease risk to be between 0.5% and 3.5% with the higher end associated with those who have radiation on the left breast. Those percentages do not include less serious heart-related issues that may not endanger life so much, but may affect quality of life. It's a small risk, but if it happens, would have a lot of implications. I do not have any health issues at this time other than breast cancer.

If I want to avoid that, I could have a mastectomy and reconstruction. While I could avoid radiation (it's not likely with the size and location of my tumor), removing my breasts (I would most likely choose bilateral) feels very permanent / there would be no going back. While I'm willing to do it if the benefit is worth it, it's hard to choose between a small chance of heart issues which would likely greatly impact life vs. removing breasts that while doesn't pose the same kind of health risk, does mean removing body parts permanently.

The other factor is that I'm young for BC at 34 so there is a higher chance of a new occurrence of BC, between 15-25% if I take tamoxifen which would be prescribed for either scenario. I do not have a family history of BC.

Rdrunner

I had masectomy and chemo and rads on the left side. they will go gated breathing for the left side, you have to take deep breath and hold it for 40secs, this pushes the heart away from chest wall thus protecting it. They cannot avoid hit a tiny piece of lung is my understanding. I finished the end of july. I have a pre existing heart issue, small hole and arrhythmia and everything is fine as far as i know. I ran 5miles today in 38 minutes , im a runner and have notice too much difference and feel stronger every week. I had to have rad as my tumor was at the chest wall.

josgirl

Hate that all I see are more women my age joining the club...I mean isn't it supposed to be 'rare' under 50 - doesn't seem that way to me now....

I am 34 too.  You can see my stats below...

I am currently doing rads (as I had a lumpectomy but also one positive node - so may have had to do rads regardlessof surgery type). Depending on your onc they may want you to have rads if there are positive nodes - something to ask - all oncs are different. Didn't see if you knew one way or the other....

My tumor was on my left side too.  I am doing the gated breathing as described in the previous post.  Rads is easy compared to chemo.  The whole reason to hold your breath is to create more space in between your heart and your chest wall.  My rad onc is super amazing and top of her game.  As with anything important, quality is not the same and doctors and practices are no different so do your homework.  They do many simulations to ensure they minimize any exposure of the rads to your heart.  The techs are super careful every day to measure me just perfect too so I am in the same pose every time.  It's no picnic and I am not thrilled to have a 1-2% risk of a sarcoma cancer 20-30 years from now but .....

I am a runner and while with all the surgeries and chemo and now rads, I have not been my typical exercise self.  My heart function is extremely important to me (and a major reason I did the TC chemo and not the ACT).  To me keeping my breast was also important and while I would have had a UMX if my tumor characteristics or genetic test had been different, to me, there was no reason to go through such a massive surgery and then more surgeries.  In the back of my head, I am so hoping to have more children and dreaming here would love to breastfeed (can off the right side) so we will see but that played into my thought process too.  And the other thing I thought heavily about was if I wanted to do a MX later as I processed through this journey then I could but I couldn't go back once having the MX.  I like my options and all the decision being made in rapid fire fashion just made me more conservative in them.  But that is me and everyone has different risk tolerances and beliefs.  Small steps....go with your gut.

Not sure if this helps or makes sense.  PM me if you want more info. 

flyjune

Thanks so much for your replies, Rdrunner and josgirl!

josgirl - I have heard that it's important to choose a quality radiation center. Do you know what characteristics I should be looking for? Someone mentioned to me that a place that has a high volume is good because they do it often. The only thing is that given that radiation is every day for 6.5 weeks, the place close to me and recommended by my UCLA surgeon, is not high volume.

In regards to my node status, I currently do not know and will find out after surgery.

rgiuff

Flyjune, I am over 5 years out from left lumpectomy and 6 weeks of radiation, done at age 47.  I remember the techs were very strict about positioning me and making sure I stayed still and would tell me when to breathe. I had absolutely no side effects at the time, nor have I had any later problems from it. I am very happy to have kept my natural breast.  Although small in size, I've always liked the shape of my breasts and didn't want to deal with the unknown of reconstructed breasts. And maybe even more importantly,  I got to keep the sensation of my real nipples.  Since going through menopause,  other areas seem to have lost some sensitivity,  but strangely enough, not my nipples. If anything,  they've become more of a help than ever in contributing to sexual sensations. 

At this point, were I ever to have to lose my breasts,  I think I would be devastated!

2ns_Jenn

I also had rads on my left and it went very well. I think I have some lingering effects (strange cough, throat clearing issues) from it but it can't be proven. I would think very carefully about choosing that option not because of concerns with heart/lungs but with the damage it will do to your skin. I had a recurrence and just completed my exchange to permanent implants after BMX with TE. Unfortunately, my rads side is not cooperating as nicely as the other side There is hardness & scar tissue that is preventing the implant from falling into place properly. From what I have heard, I am very fortunate that this is the only problem I have experienced - many others who have had BMX/implants after rads have had numerous other serious problems. I am not trying to scare you but very few doctors ever talk about those potential issues when you are discussing the options.

Best wishes in making your decision!

Jenn

angelanature

Hi Flyjune,I also have left breast ca,i had a lumpectomy with one positive node(macrometatis>9mm).I'm in the middle of radiation after finishing chemo. I'm lucky to have a proton radiation center in my state called Procure.Proton radiation is very precise and has little to no effect on your lung or heart vs. traditional radiation.It's a long drive everyday and you are on the table for an hour but worth it! I'm glad I did the lumpectomy,very small scar and my breasts are very important to my hubby and therefore me. Whatever you decide is the right decision,so sorry you are going through this,it's devastating and my thoughts are with you.

ruthbru

I had a lumpectomy and left side radiation in the summer of 2007. I had no problems related to the radiation then or later. The technology today really minimizes the chance of problems.

Having a mastectomy is not a guarantee that you won't need radiation, so don't have one if avoiding radiation that is your sole purpose. Also, a mastectomy is a major surgery with huge potential negative SEs of its own, as is the reconstruction process. Some people have no choice but to have a mastectomy, others feel in their heart that it is the right choice for them. But if you have doubts, then I would definitely go with the lumpectomy.

flyjune

Thanks for telling me about your experiences!

I met with the RO at the facility closest to me and asked him about receiving radiation in the prone position (lying face down) as well as the respiratory gating (breathing) method. He told me that neither method would be possible. The machine they use is called TomoTherapy. The person lays face up. The radiation beam rotates around the body for about six minutes (which would be too long to hold one's breath), aiming curved beams of radiation that take the contours of the body (heart and lungs) into account to minimize how much they are exposed to radiation. He also said that lying face down means that about 10% of the breast does not get radiated vs. lying face up, the whole breast is able to receive treatment.

It's hard to know what method protects the heart and lungs while also treating the breast enough...

A few of you have mentioned respiratory gating. What machine/places do this? Are the radiation beams straight then?

angelanature - Proton Therapy sounds really interesting. Do you know how it compares to standard radiation in lowering recurrence?

angelanature

Hi Flyjune,proton radiation not only reduces risk of heart disease down the road but also recurrence.Another benefit is lowered risk of other cancers such as sarcoma,etc.because is only targets breast tissue and lymph nodes(if needed).A leading radiologist oncologist from Sloane Kettering Cancer Center in ny is a personal friend of the family he recommended proton therapy for me,my brother is like a son to him,and that cinched it for me.Read up on it and see if it's right for you,hopefully there is a center near you,there are only 11 in the country and even fewer that specialize in breast ca. Hang in there,stay strong and informed,and don't rush into any decision.Hugs to you Angela

CTMOM1234

I had left-side rads nearly four years ago in the prone position. There are several threads on this board about it if you are interesting in learning more; it is considered safer to the heart and lungs and I am grateful to have given my treatments that way.

SelenaWolf

Usually, you are given a complete heart workup - including a mugga - to determine how heart-healthy you are. If it's found that you have a heart condition or a heart valve functioning issue, then radiation may be reconsidered depending on a risk assessment. Then, you have a CT scan to see how your heart is situated in your chest. It may be that your heart is deep enough in your rib cage that it won't be in the radiation field at all.

Either way, part of your treatment teams' responsibility is ensuring that radiation therapy is safe for you. If you are not sure about what they are telling you, then you should feel free to seek another opinion. There are a few ways to receive radiation therapy and you need to choose the one that is right for you.

angelanature

Hi CTMOM1234,I see you declined tamoxifen,can I ask why?I hate the sound of it but being er+pr+I thought I'd have too take it.Thanks Angela

wyo

hi flyjune

I am intrigued that you say you have no other health issues except breast cancer and are worried about the possible heart/lung damage from radiation. I wonder why people express or feel more concern about possible side effects from risk- reducing treatment than getting rid of cancer and lowering risk of recurrence? My breast surgeon and I discussed this and she feels there are so many different options today with all great treatments it creates a situation where its hard to make a decision.

I was going to have bi-lateral mastectomy and reconstruction immediately after finding out I had breast cancer but after speaking extensively with breast surgeon, plastic surgeon, husband, doing research and following my instinct I chose not to follow this path. I am not considered "young" (only to myself) I was diagnosed 3 days before my 52nd birthday

Mastectomy with reconstruction is not without its own set of factors that will absolutely affect your quality of life for a significant period of time- i.e there are risks and potential complications specifically infection, tissue expander issues, fills and exchanges,subsequent surgery and anesthesia,on-going pain control and last but certainly not least low satisfaction with cosmetic affect. I think its difficult to say the risks of bi-lateral mastectomy are less/equal/more than the risks of radiation to the left breast. I know this does not help you decide- but that is okay you have to be the one to make the decision you can live with.

angelanature

I agree wyo,having a mastectomy was out of the question at the time,I really didn't have alot of time to think about options,luckily my brother hooked me up with a leading breast surgeon,not everyone has that but I'm very happy at this point I didn't go the mx route.I'm not young either,48,but hearing stories of infection,pain and endless surgery on top of chemo and rads,ugh,I can't even think of the emotional toll it would have taken on me. Hugs Angela

Annette47

Just now seeing this thread. I had left side radiation, and was considered "young" for BC, although being 45 at diagnosis, I was older than you. I did my rads in the prone position, and had no serious problems, including no skin problems - just some swelling and tenderness.

flyjune

Hi wyo -

To answer your question about why I am concerned about side effects from treatment is because I know that either path I take will accomplish the goal of treating the cancer and possible recurrence. Knowing this, I weigh the risks and benefits of each option so I can see what the best and worst case scenarios would be and which I feel better about. There can be complications with a mastectomy, but there isn't a risk to the heart, lungs, or getting a secondary cancer. Radiation, on the other hand, has been linked to these things although the risk is small. Right now, I'm just trying to make an informed decision. Thanks.

Solen

I am 53, had my first breast cancer diagnosis at 41.  Left breast, I had a lumpectomy and radiation.  No ill effects from radiation, it was not a problem for me.  I am active and busy, no problems with heart or lung function due to rads.  I have the BRCA2 gene, so whoo-hoo cancer showed up recently  in my right breast.  I had a bilateral mastectomy, straight to implants a month ago.  I was told by first PS that I had to do lat flap, but I was not interested in that.  I had implants before first diagnosis and have had them the whole time, so my PS went straight to smaller implants.  Radiation can impact you if you later want a mastectomy.  I have had no problems with it, but many do. In retrospect, I think I should have gone straight to mastectomy, of course.  But at the time, my cancer was not aggressive and so I was advised to do lumpectomy.  I have no regrets, I have felt healthy throughout this journey.  I had radiation at Hoag in Newport Beach, they set you up with a cast to position you every time you came in, it was very directed to the area of cancer,  When I did the mastectomy, the left breast was entirely clear.  I was just DONE with worrying and being poked!!!!

CTMOM1234

Hi Angela,

Yes, after my lumpectomy and rads, I was given an opportunity to take tamoxifen daily for 5 years. I was 44 years old at that time, pre-menopausal (still am four years later), and take no medications other than a single baby aspirin daily (I started doing this after my diagnosis for preventative measures). The important thing to remember is that with each medical treatment, there are risks and benefits, and although none of us wants to do this, we must run our own "cost benefit analysis." I reserved the right to change my mind at any time -- but have not yet.

I'm truly glad I was given the option and had the lumpectomy and left-side rads in the prone position rather than a mastectomy. I had reservations about tamoxifen and am grateful to have met with an oncologist who explained everything very analytically (I'm a statistician). Based on my medical situation, taking tamoxifen for 5 years was minimal, increasing my chances of having no recurrence over that time period from 95-96% to 97.5-98%; perhaps I'm less risk averse than others, the 2-2.5% advantage was not worth altering my hormones, but these are such personal decisions, and, of course, just statistics. If my numbers were different or I just wanted to do everything medical available to minimize my odds (which I respect that many women want for inner peace, but that is not really me), my decision may have been different. The strongest argument for my taking tamoxifen was actually to minimize the potential of a new diagnosis on the right side, something that I did consider, but again, I did not feel the potential long- and short-term medical issues offset the potential advantages.

Make informed decisions, and then have no regrets, that's my motto.

angelanature

Thanks CTMom1234,I quess I fall into that do everything slot,my oncotype dx was 18 and i'm brca neg,and I still put myself through dose dense act and now 35 rad txs,sucks big time! The worst burns of my life and a 4 hour deal everyday with the drive. Breast cancer was my greatest fear,I loved my perfect boobs(as did my hubby)and would have rather have my leg cut off,or an organ,anything.I hate that I probably brought this upon myself as you draw in and manifest your fears.I'll do anything to prevent reoccurance even if my chances are low,hopefully I won't lose a leg or something now I've put that out there.Ang