YouTube video by Dr. Jenn (Jenn Simmons, MD) explaining what radiation therapy for breast cancer does, emphasizing that radiation is a local treatment with no overall survival benefit and that its main effect is to reduce local recurrence risk. The video highlights that the benefit varies by individual tumor biology and risk, strongly warns BRCA (and similar DNA-repair mutation) carriers against radiation because of increased sensitivity to DNA-damaging effects, and urges patients to have frank discussions with radiation oncologists and seek second opinions.
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Hi there, it's Dr. Jen. You asked and I answered. Today we are talking about radiation. I've been getting a lot of questions from individuals who want to know if they should get radiation. And I, I think in order to answer that question, because I think that that answer is different for everyone. We first need to understand what radiation is, what it does and what the benefits are. Many people are under the impression that radiation improves survival. And this is a big reason why I wrote my book the Smart Person's Guide to Breast Cancer. Because I think that everyone, before accepting, before signing up for any of these treatment modalities, we need to really understand what the benefits are and what the risks are in terms of radiation. We first need to consider the fact that there is no survival benefit to getting radiation. For anyone. For anyone. Radiation is a local treatment. And when we think about the treatments for breast cancer, we divide them up between local treatments and systemic treatments. The local treatments for breast cancer are surgery and radiation, the systemic treatments for breast cancer, chemotherapy, anti hormonal therapy, anything that's going to work on the whole system. So the local treatments for breast cancer being surgery and radiation. And we're talking today about radiation. When I say local, I mean it only treats locally, it only treats the tissues of the breast. Maybe sometimes they include the lymph node basin in their treatment area, but it's only treating locally, it's only acting locally. And for that reason it has no effect on what happens in the system. So what radiation is powered to do is to prevent recurrence. And the amount that it prevents recurrence depends largely on the individual, their individual risk factors for recurrence and the tumor biology. So there are some tumors that are just more prone to recurrence than others. And it's only in that population probably that radiation has any real advantage. But it's difficult, it's difficult to determine if you're in that population or not. There are some things that we can use to try to help make that determination. We can use how rapidly those cells are dividing. We can use some of the biologic characteristics, like if it's triple negative, those tend to be more aggressive and have less treatment solutions. But the one population that I want to focus on today that needs to be very careful about radiation are the BRCA mutation carriers. These individuals that carry a BRCA mutation, that BRCA gene is actually a protective gene. It's an anti cancer gene, it's a DNA repair gene. And when you don't have proper functioning of that gene, you are even more susceptible to the things in the environment that damage DNA. And one of the main things that damages DNA is radiation. So for people with BRCA mutations or other mutations that make people more vulnerable to these environmental insults, these are the people that should be avoiding the radiation and other other such things at all costs. So these are people who should not be screening with mammogram. Absolutely not. They should not be getting radiation as part of their treatment plan. And they have to be careful with things like the electromagnetic field. They're going to be even more sensitive to environmental insults. So if you're not a mutation carrier and you're considering radiation, make sure that first of all, you should absolutely read my book. And it's called the Smart Person's Guide to Breast Cancer. We'll make sure to put the link attached to this video. But you also need to have a very honest, frank and informative conversation with the radiation oncologist and truly understand what benefit that you have to getting radiation. Because if the benefit is not there, the risks certainly are. And I don't think that lowering a local recurrence risk by a couple of percentage points is worth the long term damage that comes along with radiation. And it's not just fibrosis or firmness of the breast tissue. And it's not just deformity of the breast tissue, it's the damage that is done to the chest wall, it's the damage that is done to the bones, it's the potential damage to the lung, to the heart. These things all need to be taken into consideration because they have very serious systemic implications. And you will not live as long if you don't have well functioning lung tissue. You will not live as long if you don't have a well functioning heart. You will not live as long if you have damage to the blood vessels of the chest wall and of the chest and of the heart. So all of this really needs to be taken into consideration when you're considering radiation. And I hope that this is an honest conversation that you can have with your radiation oncologist. And if they're resistant to having this conversation for you, you have to consider what that means and either go see someone else, get a second opinion, get a third opinion, continue to get opinions until you get the answers that you're looking for. And that decision of what to do is crystal clear to you. It's Dr. Jen, bye for now.
