She was known for playing Sally Hardesty in Tobe Hooper's horror film The Texas Chain Saw Massacre (1974), which established her as a scream queen and a catalyst of the final girl trope.

However, for the established actors Anthony Perkins, Blythe Danner and Beau Bridges to appear, they wanted newcomer Susan Sarandon to be cast in the role instead.

She plays the character of Sally Hardesty, a teenager who travels with her brother and some friends to the cemetery where her grandfather is buried to investigate reports of grave vandalism, and then encounters a family of cannibals including the chainsaw-wielding Leatherface.

[13][14][15][16] In an article for Texas Monthly detailing the production of the film, John Bloom reported that Burns had "been poked, prodded, bound, dragged through rooms, jerked around, chased through cocklebur underbrush, jabbed with a stick, forced to skid on her knees in take after take, pounded on the head with a rubber hammer, coated with sticky stage blood, and endlessly pursued by Hansen with his chain saw and Neal with his constantly flicking switchblade.

[21][22] Writing for The Cincinnati Enquirer, Donald B. Berrigan stated that Burns "deserves a special Academy Award for one of the most sustained and believable acting achievements in movie history.

"[24] The acting of Burns has continued to earn praise from critics and audiences, and established her as a scream queen and a popular culture icon.

Recalling her memories of working on Helter Skelter, Burns said: "It was a great experience, but nobody really wanted to touch it [due to the subject matter].

[37] In 2012, Burns made a special appearance in the Kim Henkel-written feature Butcher Boys, which is often deemed a "spiritual sequel" to The Texas Chain Saw Massacre.

[41] Her final film roles include Beulah Standifier in 2014's Sacrament, and Ms. Hill in the independent feature In a Madman's World, which was released posthumously in 2017.