Left breast radiation

Anonymous

Left breast radiation

starbaby_1

From what I've read, radiation to the left breast inevitably affects the heart and lungs. I already have a family history of heart disease and have been on BP medicine and a statin for many years now. I also have venous insufficiency - so I have an existing vascular problem. My cancer area was very small and the margins were clear after lumpectomy. There is no lymph node involvement. My onco score was 17 so I am on the low end of recurrence but my cancer is invasive. I have an appointment with the radiologist next week and at this point, I am leaning towards taking my chances without radiology. I know that newer methods are out there that supposedly limit the risk of heart or lung damage. But if I don't get an assurance from the doctor that my heart will not be affected I feel that the risks outweigh the benefits. I understand that the potential heart issues happen months or years after treatment so the radiology facility is basically off the hook. Does anyone have any advice for me?

AliceBastable

I was assured by the radiologist that there wouldn't be damage. About a year later, I made an appointment with a cardio-thoracic surgeon to start tracking an aneurysm that's just below the heart (found before radiation, so no connection). When I mentioned that I'd had left breast radiation, he thanked me and said there is ALWAYS damage, so that kind of shook me up. I get periodic chest and abdomen CT scans for a different issue, and besides some standard small nodules in the lung (which apparently are pretty normal as long as they don't grow), a smudgy spot started appearing on the left lung, which the reading radiologist attributed to radiation scarring. Eek! But it stayed stable on the next CT, and on the last one, it's faded considerably, so it may have been temporary. I saw the cardio-thoracic doctor again a year after the first appointment, and that time, I realized that he's Dr. Eeyore - EVERYTHING is a potential disaster! And the CTs I've had show absolutely NO damage to my heart, for what that's worth. I also had an ultrasound about 18 months ago, and it showed that my heart is in good shape.

I also have venous insufficiency. It was really nasty after my hip replacement 11 years ago, and I had to go to a wound clinic for several sessions and slap on all kinds of nasty concoctions to clear up the leaking. Now it's controlled with compression socks. None of my doctors have ever mentioned that as a factor in getting radiation or any other treatment or surgery.

starbaby_1

Hi Alice and thank you for your reply! Of course the first thing that you want to do when you get a cancer diagnosis is to get it out. I met with my team - surgeon, oncologist and radiologist but it never even dawned on me that left side cancer is near the heart nor was it mentioned. Now the surgery is done and I have to take the next step. I feel like its a roll of the dice. I called the surgeons office and his nurse said that I am "married" to radiology because I chose lumpectomy. I don't feel that way because it is my body and my choice....My quandary is should I get the radiology or opt out and choose the anti-hormonal drug only? I read many articles that warned about radiation damage to the heart but they were all written around 2013. I would hope that there are some advancements to treatment since then. Oddly I can't find anything current on the subject. The older articles said that the heart damage doesn't occur immediately - it typically happens several years down the road. I'm thinking that my next step should be to get a current echocardiogram so I'll know exactly the state of my heart now. I'm 65 years old and I was told that women over 70 don't need radiation. I'm curious about why when the average life expectancy is well into the 80's. There's a You Tube video from an Israeli doctor that believes that cancer should only be treated when it is present due to the risks associated with radiation - It's called "Irradiation of the left breast damages the heart". He references studies by the New England Journal of Medicine too....If you go into You Tube and put in that title it will pull it up.

My cancer was very small - 9 mm and only 1 mm after pre-surgery biopsy. The margins were clear after surgery and there was no lymph node involvement - but it is a grade 2 which scares me. Thank you for letting me know about your experience. I have an appt next week with the radiologist so hopefully she can shed more light on this.

I wish you continued health. I so much appreciate the support of others going through this. Thanks again. Debbie

AliceBastable

My Mom had breast cancer when she was 85 and she went through the full 33 sessions of radiation. I've never heard that women over 70 don't need it. Does your radiology department offer prone position radiation, which is supposed to keep the beams away from the heart and lungs?

starbaby_1

That is a very good question. I am going to ask that at my upcoming appointment. I don't know if you have to be a very large woman to do that?? I have so many questions - especially since I got my pathology results. I find myself looking up EVERY term to make sure that I understand them and can talk intelligently. The surgeon's nurse told me to stay away from the internet. I don't know why. It seems to be the only place that I can get answers.

Like others on this site, I am scared and confused. I really want to make good decisions. Until this happened to me I really didn't understand how much of breast cancer treatment seems to be a gray area.

I just know that I feel a lot better reading about others and talking to someone as kind and caring as you. Thank you!

Betrayal

Usually the prone position is reserved for large breasted women but that can vary by institution. They teach breath holding techniques for left sided BC radiation to pull the heart out of the beam field. Some use a device to do this while others just require a deep breath for each pass. My mass was located at 6:30 (think clock) so left inner, lower quadrant. I had 33 sessions and 8 of those were boosts because my margin was clean but very slim (think paper thin). That was 5 years ago and I just had an echocardiogram for a murmur detected by my rheumatologist (missed by other HC providers) and it showed no evidence of radiation damage, just age related changes. Ask questions about what collateral damage can occur due to radiation and ask about things such as breast tissue fibrosis, skin changes, breast size changes, etc. gathering all the info you can to help you make a decision.

Do stay after from the internet because there is more bad info than helpful info. Come here and ask questions since we are all willing to be your support system and offer our experiences to help you. Good luck.

Alcie1

Radiation "therapy" certainly does affect tissues and organs, not just the breast. How much depends on the type of radiation, what protections are used and where the beam is going. It doesn't just stop at the tumor bed.

There is an article, from a study, on some older women not needing radiation on the BC.org website. You should be able to search for it. See the search line at the top of the page. Or just google it.

My experience with having had radiation years ago was awful and I am not having it with my new cancer. I'm old, and with both my small cancers I had all positive numbers, which should have qualified me for not having rads according to the article which had just been published, but I was told I "had to have" it and so I did .... the first time. Lateral left breast, focused radiation with all the protections, and it still hit my stomach, lung and a couple of ribs. I was extremely anemic and sick and did not recover for months. My treatment made the area hit to be "cooked" until it's like a piece of microwaved chicken, a thick, firm area in the breast. I'm told the rib will probably break sometime.

My new tumor is in the same breast, but it's on the medial side by the heart. My new radiation oncologist this time told me not having radiation would not change my mortality numbers. I need plastic surgery, which can't be done successfully after radiation. My surgeon is angry with me. But my breast is so ugly I can't live with it and want it repaired or off. My rad. onc. gave me the choice after carefully going over all aspects of the issue.

starbaby_1

Hi Alice,

Thank you for your response. Like a lot of others, I was totally freaked out by having the cancer diagnosis. And I feel like the surgeon and the oncologist should have at least mentioned that there is some risk to radiation on the left side. From what I know about my diagnosis, my cancer was small and very early stage. Because of my onco score, there is a 90% chance that it won't return. The radiation brings that percentage to something like 93%. So I wonder if it is worth the risk for so little return.......90% sounds like a pretty promising number to me!

So I am meeting with the radiation oncologist later this week. I am certain that there will be a huge push to get it done. But I have to think about the future as it seems that issues usually show up well after treatments are completed. I also read that there are new radiation treatments that can be performed along with surgery. One treatment to the breast right after surgery with the same effectiveness of 5-7 weeks of radiation. Makes me wonder...

Thank you though so much for sharing your candid and personal experience.......I am leaning towards foregoing it at this point. I feel like its a roll of the dice no matter what you do.

santabarbarian

I did proton beam radiation for the very reason you cite: worry about heart damage.

Proton beams 'stop' in the tumor bed without passing through the body. I started a thread about it: Proton Radiation: Share your Experiences.

RatherBeSailing

Starbaby -

I know you said you have high BP and are on a statin, but it sounds as though your heart is in pretty good shape?

And your recurrence odds are favorable either way, which is great news!

Some cancer centers have onco-cardiology departments, with doctors who possess both in-depth knowledge of the heart and also possible complications from cancer treatments - and, most important, how to address any complications. If you are worried, perhaps you should try and schedule a consult with an onco-cardiologist before you make a decision? They might give you a better sense of risk in your particular case.

And your RO should be able to give you an estimate of what the heart dose would be. If they're not covering your nodes, it should be pretty low, even with left-sided cancer. You could take that info the cardiologist.

These choices are so difficult. Hope you can come up with a decision you're comfortable with.

ctmbsikia

I had treatment in the prone position after the breath hold planning failed. I don’t know why they don’t do it this way for left. My tumor was at 11:00 spot and I felt safe having my heart laying on a metal plate. Good luck to you.

I also had an aunt who did not have rads as she was 70. She just turned 85.

starbaby_1

Thank you all for your great advice. I am planning on seeing a cardiologist after I meet with the radiologist before I make a decision. I am almost 65 years old and I know that there is some new info out about the possibility of skipping the radiation for older women. Just not sure I'm old enough! LOL - maybe the ONLY time it pays to be older?? Anyway, if radiation in the prone position was available that sounds good but I'm not sure I am large breasted enough. Geez - not old enough, not large breasted enough - I can't win.......

I will let you know what they tell me as far as the amount of radiation and any variations of treatments that they might offer. Its so wonderful to know that there is support out there!!!!!

Salamandra

I had a right side tumor and I don't think of myself as very large breasted but I had prone radiation. I wonder if it might depend on the treatment center and its facilities?

My RO was also supremely confident that radiation wouldn't cause me any ancillary damage... I am willing to believe that due to the lag between treatment and evidence of long term effects, things may be better now than they used to be. Of course for the same reason, it will be a while before we have the studies to show it with evidence!

There was a woman in her mid 80s getting radiation with me. She said she didn't want to do the hormone therapy and the docs really pushed radiation on her. I think she had somewhat more fatigue than I did, but was basically fine.

My understanding is that the idea that low risk older women can skip radiation is based on the idea that their projected lifespan is lower so long term protection against recurrence is less of a priority. I think that how that might resonate for any given 65 year old might depend on whether her own parents lived until 70 or lived until 95, as well her assessment of other health factors. I guess the flip side is that long term negative health impacts of radiation would also be less of a concern. To me it seems like another factor would be anticipated sturdiness for possible future surgeries.

farmgirl888

IORT is the radiation they do during surgery.

https://community.breastcancer.org/forum/70/topics...

starbaby_1

Wish I knew about this before I got the surgery........

KLR63

My raditation oncologist used the V-MAT version of rad therapy to make sure my heart wasn't effected. I had left breast, lower interior placement of my tumor. It's a form of IHRT but uses an arc.

KLR63

I was told the ONCO score reflects distant occurrence possibilities and radiation is for local reoccurrence. It's the reason I chose to do it. it's supposed to catch any small or unseen cells in the breast and nodes.

starbaby_1

Thank you!! It seems that there are a lot of ways to protect the heart. Here's hoping that my center offers one of them.

You girls are great! I feel so informed going into this now - unlike I did before surgery. Tomorrow is my big day with the radiologist!

Trishyla

Good luck tomorrow, starbaby. I hope they can answer all of you questions so you can make the best decision for you.

Redkitty815

The Radcomp trial that is currently underway is studying the long-term effects of left-side radiation and damage to the heart, comparing photon and proton radiation. That might be of interest to you if you qualify/have proton accessible.

I had photon radiation, left side. The breath hold method reduces damage on the organs by pulling them out of the field, but radiation is no picnic, or, at least, it wasn’t for me. I am in my 40s with grade 3, node positive cancer. I decided the risk was high enough to do everything I could and radiation significantly reduces the risk of local recurrence. Your radiation oncologist should be very familiar with risks and benefits and able to talk you through them.

msphil

hello sweetie I too had left radiation after L mast wanted lumpectomy cause we were planning our 2nd marriages at diagnosis but decided on mastectomy with reconstruction but body rejected the expanded implant as foreign body was removed. I went back to work with shortness of breath trying to walk down clinic to my office. Was diagnosed with asthma then rushed to ER with severe shortness of breath diagnosed with congestive heart failure was told fiance got me there in time for young basketball player died on floor not knowing he had CHF. Then yrs later had pacemaker implanted 2007 then 2009 removed to implant ICD which is a pacemaker n defibrillator combined. Thank God never went off. And since then doing great most people say after I tell what been thru they say you dont look like you been thru any of that. Now Praise God Im a 27 yr Survivor and also our 27th wedding Anniversary this yr. So its doable. msphil IDC stage2 0/3 nodes L mast 3mo chemo before and after got married then 7wks rads 5 yrs on tamoxifen. Hope this helps Imma here to Inspire.

starbaby_1

Well I met with my radiation oncologist this week. She started out by interpreting my pathology results. I listened to her but I had done so much research on them myself that I pretty much knew all that she told me. The one thing though that really made me think was the DCIS margin. It is only .5 mm. I was only paying attention to the IDC margins which were >7mm. So this caused me to rethink a lot!

I was extremely happy to hear that they did radiology in the prone position. My tumor was at the 11 o'clock position on the inside area of my breast. She actually had a copy of one of the MRI pictures (which was done in the prone position) because I was worried that I might not be large enough. In looking at that picture it was clear to see that the prone position would work out well for me in radiology as well.

To my surprise she had already planned to map me at this session. She didn't seem very happy with me when I told her that I was super concerned about my heart - due to my family history and already existing blood pressure issues. I also told her that I had made an appointment for an echocardiogram next week. I don't know if she said it to scare me or not - but she said that due to the very small margin with DCIS that some women would have another surgery to improve their margins or think about a mastectomy. I think she said that because she could see that I clearly was not sold on radiation treatments.

She also explained that no matter how diligent they are and what angles they use, "some" particles of radiation will hit the heart and lungs. So the way we left it was that I have the echo next week to see what the current condition of my heart is and then I will make a decision about radiation. I honestly believe it is an extra level of protection for future reoccurrence but if my heart has any issues, I might be willing to forego radiation for drug treatment only. I feel like a heart issue is much more likely to result in a life threatening scenario than a reoccurrence of breast cancer. Such a terrible decision to have to make.

So I am praying that all is well with my heart and I will schedule the radiation. it would be a total of 50 grays given over 20 treatments - I believe that this schedule is referred to as hypo fractional as it is faster than the normal course of treatment with the last week being "booster" shots. (In reading about it - it sounds like it has a very favorable outcome with less tenderness and reduced side effects.)

Fingers crossed that everything works out....