Who Needs Radiation Therapy after a Mastectomy?

There is a lot of controversy about who needs to get radiation after a mastectomy, particularly if they have one to three lymph nodes positive. Here is what I like to tell my patients. There is an ongoing controversy these days about who benefits from radiation in the setting of node positivity. We have historically known that women with four or more lymph nodes need to get radiation to the lymph nodes, particularly if they have had a mastectomy,that would be one of the strong indications for proceeding with post-mastectomy radiation. In the 1998 or so, two studies came out that suggested that there may be a benefit, particularly in younger women to get post-mastectomy radiation for one to three nodes positive and that began this whole controversy that continues today and there is ongoing data that continues to raise the question as to is there a benefit and how big is that benefit for a woman with one to three nodes positive. It is one of those topics that I spent hours with patients discussing because there are arguments on both sides. Particularly, if a woman has had a mastectomy and is having reconstruction, the downside to doing radiation is that it may significantly impact upon her reconstruction. Otherwise, the radiation is relatively safe and the downsides of it are fairly minimal, so that for women who are having a lumpectomy and have one to three nodes positive, it frequently is a much easier decision because we are already doing radiation, so it certainly feels a little bit bigger, does not change things that much, but it is really in the setting of post-mastectomy radiation that we really come into the controversy and it is a case by case scenario. It depends, I always looked at it, how many negative features are pushing me to suggest we may need to do it, is it someone who may have what we call lymphovascular invasion where the tumor is showing evidence of being in some of the lymphatic vessels streaking away from the actual cancer suggesting that there may be a higher recurrence rate in the chest wall or is it someone that may have extranodal extension, tumor extending outside the lymph node into the adjacent fat. So there are many factors that go into play and it is again something that needs to be discussed with the radiation oncologist and each patient has an individualized decision making and will be a participant in that decision making as well because it is not a black and white decision. Hi, I am Dr. Jay Harness and I want to share with you important information that I believe that every newly diagnosed patient with breast cancer needs to know. Susan Denver: I am a breast cancer survivor. Katherine Stockton: I am a breast cancer survivor. Coree: I am a breast cancer survivor. Susan Denver: And I want every woman to know... Katherine Stockton: ...about personalized breast cancer treatment... Susan Denver: ...and the Genomic Test. Coree: A test that helps guide a woman and her doctor... Katherine Stockton: ...to the best treatment options for her. Susan Denver: Pass it on!