DEAR DR. ROACH: I had breast cancer in my left breast 14 years ago. I was treated with chemotherapy and radiation after a lumpectomy and the removal of 14 lymph nodes. I still have difficulty raising my left arm, along with burning, tingling and itching in my armpit area. I have a small scar on my lung and cracks in my ribs.

Four years ago, I developed red streaks on my breast that were finally diagnosed via an MRI as a late effect of radiation. This past year, I developed a thickness that was diagnosed as radiation fibrosis. I now have heart vessel issues that are most likely attributed to radiation.

This past week, I experienced intermittent, quick, stab-like pains in my left breast. Testing revealed that the pains are not heart-related. As it appears that the radiation therapy has caused so many problems, could this also be a side effect of it after so many years?

• C.R.

ANSWER: I am sorry to hear about these persistent symptoms. All three common treatments for breast cancer have the potential to cause side effects.

What is particularly frustrating about radiation is that sometimes the adverse effects don’t show up until months or years after the treatment. In one long-term study, 38% of women who were treated with radiation and surgery had breast pain sometime between 10-17 years after treatment, compared to 24% of women who were treated with surgery alone.

Pain can be due to damage from fibrosis or damage to the nerves themselves. It is very plausible that the pains you are getting could be related to the radiation from all those years ago. However, I can’t be sure that radiation is the cause.

You were very wise to get your heart evaluated. Many women do not think themselves to be at a high risk for heart disease, even though heart disease is still the biggest killer of women. Radiation to the chest can cause damage to the blood vessels to the heart, as is apparently the case with you, and this can predispose people to heart attacks.

You should consider preventive treatment for heart disease, and your doctor should have a lower threshold for treatment for you than for a woman who hasn’t had radiation. If you had platinum-based chemotherapy, this is also an independent risk for heart disease.

Treatment for radiation-induced breast pain includes non-pharmacologic therapies like exercise and cognitive behavioral therapy. Acupuncture has fairly strong evidence of benefit when it comes to this situation.

When medications are needed, and over-the-counter medications aren’t adequate, medicines like duloxetine or gabapentin can be helpful — especially given your description of stab-like pains, which may represent pain from the damaged nerves.