Radiation Fibrosis and Breast Cancer: How to Alleviate Your Pain at Home

By Jaclyn Amaru, PA-C

October is Breast Cancer Awareness month and being a Physician Assistant, I see patients all too frequently plagued by this devastating disease process. According to the American Cancer Society  246,600 new cases of breast cancer will be diagnosed this year. It is the most common cancer in women, but it can also be diagnosed in men. It is likely that you know someone right now that suffers from breast cancer.

Not only is breast cancer and the fight to beat it a long, hard road, but also dealing with the aftermath of chemotherapy and radiation can be equally as debilitating. In 2011, it was quoted from a radiation symposium that some two-thirds of all cancer patients will receive some form of radiation treatment. There is a disease process associated with radiation therapy that receives little to no attention in the media or literature as it relates to breast cancer, yet many suffer its effects. This disease, known as Radiation Fibrosis (RF), is a major cause of long-term disability. However, there is an investment you can make for yourself to help aid in the pursuit of improved quality of life.

RF, considered an intermediate complication of radiation in a paper by Yi and colleagues in 2009, is the name given to the disease process referring to the underlying tissue remodeling, on a muscular, skeletal, vascular and lymphatic level, due to the effects of radiation treatment. This remodeling happens gradually due to the abnormal production of the protein fibrin and can present years after therapy has been completed. But not everyone who undergoes radiation treatment will develop RF. RF is more commonly discussed with regards to other cancers, such as Hodgkin’s Lymphoma and head and neck cancers due to the higher level of radiation that is administered. However, RF can occur in any tissue, including preserved breast tissue, and/or chest wall tissue post-mastectomy.

RF, as it relates to breast cancer, may manifest as muscle spasms, vague stiffness or tightness in the arm or chest wall, sensory loss, burning pain and/or muscle fatigability most commonly in the arm, breast tissue and pectoral muscle. In some cases, if muscles running adjacent to the vertebrae are involved, neck and shoulder pain can be seen as well. If breast tissue is left intact, radiation may either shrink the tissue increasing its density, or enlarge due to lymphedema. Cording, or the feeling of cords running from your armpit down your arm due to lymph fluid being stuck in thickened lymph vessels, is another common finding. Therefore, one can imagine that radiation to the breast has the ability to cause problems like trouble swallowing, shortness of breath, reduced range in motion and chronic pain, thus severely affecting quality of life.

There is no cure for RF and treatment is challenging and highly individualized. Physical, occupational and lymph drainage therapy are all major players in a multi-disciplinary rehabilitation approach, utilizing techniques such as neuromuscular re-education, myofascial release and manual lymph drainage. Typical physical therapy for orthopedic injuries is not sufficient, as things like heat and ultrasound are highly contraindicated. Therefore, it is extremely important to make sure the therapist treating you has extensive experience in the post-radiation field and holds the necessary licenses.

Being that not all patients have access to specialized rehabilitation programs or maybe can’t make appointments as frequently as they would like to go, I would like to advocate for a small, hand-held tool that can be utilized at home, as an adjunct to a professional therapy program. Posture Prep, created by Dr. Pat Bona, is a massage tool that aids in myofascial release, or the softening and elongation of tightened tissue held together by fascia, allowing for fluid to flow more easily. Although the ACS published a guide in 2009 indicating “little scientific evidence