Abstract
Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in American women. Postsurgical adjuvant radiotherapy (RT) significantly improves local-regional recurrence and breast cancer survival, so currently most breast cancer patients receive RT after surgery. However, pain related to cancer or treatment is a critical quality of life issue for breast cancer survivors. Most of the previous studies have focused on chemotherapy-related neuropathy; however, many breast cancer patients undergoing RT experience clinically significant levels of unrelieved cancer pain despite standard pain management. Multiple risk factors contribute to pre-RT, post-RT, and RT-related pain. Considering pre-RT pain is an independent risk factor for post-RT pain, and also RT-associated pain can last for many decades, pain management during RT may be an effective preventive strategy. Furthermore, if hypo-fractionation RT can provide equivalent long-term tumor control and survival but with reduced RT-associated pain, it may present a cost-effective treatment strategy to improve RT outcomes. Lastly, compared to non-Hispanic Whites, underserved minorities are more likely to suffer worse RT-related pain. Therefore, future research is warranted to characterize the molecular mechanisms of RT-related pain disparities and identify high-risk population for precision intervention.