Breast Radiation Side Effects
The most common breast radiation side effects are skin peeling in the area being treated, fatigue, redness, and swelling.
In general, the side effects depend on the type of radiation therapy you’re having (external or brachytherapy/internal), the technique (whole-breast or partial-breast radiation), and the area being treated (the breast or an area where the cancer has spread, such as the lymph nodes).
Radiation side effects tend to develop as treatment goes on and may be more troubling toward or after the end of treatment. Still, most side effects caused by radiation are short-term and tend to clear up six to 12 months after treatment ends. But there are some side effects that may develop later or last longer.
External radiation therapy side effects
One of the main side effects of external radiation therapy is skin changes in the treated area.
The reaction is much like a sunburn, with redness and possible itching, burning, soreness, peeling, blisters, or darkening of the skin. These skin changes happen gradually over the course of treatment and may happen only in certain areas.
Places where skin touches skin, such as the armpit and the area under the breasts, and places where you may have had a lot of sun exposure, such as the upper chest, are more likely to be affected. Some people have a change in skin color that lasts for years after treatment.
Some people may have telangiectasias (sometimes called spider veins) that develop months to years after radiation to the breast. A telangiectasia is a small patch of tiny blood vessels on the skin of the treated area that looks like a tangle of thin red lines. Telangiectasias are not a sign of cancer recurrence, but they can sometimes cause bothersome symptoms such as itching or pain. If you develop telangiectasia after radiation therapy and wish to treat it, you can talk to a dermatologist (skin doctor) about laser therapy or other treatments.
You may be more likely to have significant skin side effects if you have fair skin, larger breasts, certain health conditions that affect skin healing (such as a connective tissue disorder), or if you had mastectomy or chemotherapy before radiation.
Any skin side effects you have may continue to get worse for a week or so after you complete treatment, but then your skin starts to heal.
Other side effects of external radiation therapy
Other short-term side effects that external radiation therapy may cause are:
swelling in the breast
mild to moderate fatigue
changes in skin sensation
Less common side effects are:
arm swelling (lymphedema), particularly in cases where lymph nodes are treated
shoulder stiffness
Brachytherapy (internal radiation) side effects
The main side effects of brachytherapy are:
skin changes in the treated area, including redness or bruising
breast pain
damage to fatty tissue in the breast
fluid collecting in the breast
Again, these side effects are usually short-term and clear up after six to 12 months.
Possible long-term side effects of radiation therapy for breast cancer
Although most breast radiation side effects ease after six months to a year, there are less common side effects that may develop later or last for several years or more.
In some cases, the breast becomes smaller and the skin becomes firmer or swollen.
Women who have had breast radiation may not be able to breastfeed from the affected breast.
If you’ve had radiation to any lymph nodes, lymphedema can be a long-term side effect.
It’s not common, but breast radiation can sometimes cause damage to some nerves in the arm. This damage is called brachial plexopathy. Brachial plexopathy may lead to numbness, pain, and weakness in the arm, shoulder, or hand.
Advances in radiation therapy have greatly reduced the amount of radiation exposure to the heart and lungs. Newer radiation equipment tracks heart beats and lung movement (called respiratory gating) and effectively blocks those tissues from radiation exposure, so lung and heart damage from radiation are rare today.
In very rare cases, radiation may weaken the ribs, which may lead to a broken rib.
There is also a very low risk of developing a secondary cancer. Still, the benefits of treating an active cancer now usually far outweigh any risk of a second diagnosis later.
How to manage skin side effects of radiation therapy
There are a number of things you can do to help make your skin less sensitive during radiation treatment and also help your skin heal after radiation treatment is completed.
Here are some steps you can take to help prevent and treat irritation before and after daily radiation treatments.
At the beginning your radiation treatment, before you have any side effects, moisturize the skin after your daily treatment with a mild ointment.
You also can put moisturizer on at night — wear an old T-shirt so the ointment doesn't get on your bedclothes.
If your skin becomes dry and flakey during the course of your treatment, moisturize frequently and cleanse skin gently.
Wear loose-fitting shirts, preferably made from cotton.
Avoid wearing underwire bras or any bra that digs into your skin. Don’t wear a bra if there are raw areas.
Use warm rather than hot water.
Try to not let the spray from the showerhead directly hit your breast. Let the water hit your shoulder and run down over the affected area.
Avoid strong soaps and soaps with fragrance. Use fragrance-free soaps with moisturizers or soaps made specifically for sensitive skin.
Avoid scrubbing with washcloths or loofahs.
To help prevent redness and skin irritation, avoid skin-on-skin contact that can cause friction, moisture, pressure, and heat. The areas that are most likely to get irritated are:
the armpit: where your arm presses against your armpit and the outer part of your breast
under the breast: along the bottom crease of your breast, where your breast might droop a bit and lie against your upper belly wall
between the breasts: along your cleavage where the breasts may touch each other
To avoid skin-on-skin contact:
Try to keep your arm away from your body whenever possible.
Wear a supportive bra without an underwire to keep your breasts separated and lifted.
If you have large breasts, when you’re not wearing a bra, place a soft washcloth or piece of flannel or soft cotton under your breast.
Regularly dust the breast area and skin folds with cornstarch to absorb moisture, reduce friction, and keep you smelling fresh.
You can use baby powder made from cornstarch (don't use talc) or sifted kitchen cornstarch.
Apply cornstarch with a clean makeup brush or put some cornstarch into a single knee-high nylon or thin sock and knot it at the top. Gently tap the sock against the skin to dust the surface.
If your doctor has recommended using creams or salves, apply those first, then dust the area with the cornstarch.
With or without radiation, yeast infections are common in the skin fold under each breast — particularly during warm weather in women with large breasts.
Signs of yeast infections are redness, itchiness, and sometimes a faint white substance on the skin.
If you have a yeast infection, take care of it before radiation starts so it doesn’t get worse.
An anti-fungal cream or powder (such as athlete's foot medicine) usually works well.
For mild irritation, itching and burning, you can apply an aloe vera preparation. Or try an over-the-counter hydrocortisone cream.
Spread the cream thinly over the affected area three times a day but don’t use aloe or cortisone cream in the hour before radiation treatment.
If areas of your skin become red, itchy, sore, or start to burn, and the over-the-counter hydrocortisone cream doesn’t help, ask your doctor for an alternative.
Some people get some relief by blowing air on the area with a hair dryer set to “cool” or “air” (no heat).
If your skin forms a blister or peels in a wet way, leave it alone. The old skin protects the new skin while it grows back underneath.
If you develop a blister and it opens, the exposed raw area can be painful and weepy. Tell your doctor if this happens so you can help keep it from becoming infected.
Keep the area relatively dry and wash it with warm water only. Blot the area dry and then apply a non-adherent dressing, such as Xeroform dressings (which have soothing petroleum jelly) or “second skin” dressings made by several companies.
To relieve discomfort from blistering or peeling, take an over-the-counter pain reliever, or ask your doctor for a prescription if you need it.
If skin problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover.
Radiation side effects FAQ
What people sometimes call a radiation burn is not actually a burn. It’s the redness, itchiness, peeling, and blistering of the skin that radiation can cause.
Radiation only causes hair loss to the area being treated. So radiation to the breast area doesn’t cause hair loss on your head. But if you’ve been diagnosed with brain metastasis and are scheduled to receive brain radiation therapy, it’s common to lose some hair.
The breast radiation treatment procedure is painless. Still, over time, you may have some skin discomfort, including itching, redness, and blistering.
— Last updated on February 23, 2024 at 9:07 PM