Putting the patient first: new ways to treat breast cancer

Breast cancer is the most common cancer diagnosed in women in Australia and worldwide.^1,2 , Although breast cancer is still one of the leading causes of cancer-related deaths in Australian women, an increasing number are successfully overcoming this disease.² These improvements in breast cancer survival are due not only to advances in screening and early detection, but also to advances in treatment and delivery of care.^2,3

Radiation therapy is an important part of the multidisciplinary treatment of breast cancer and is typically used in combination with other types of treatments.^4,5 In patients with breast cancer, radiation therapy is usually given after surgery to reduce the risk of the cancer returning.^4,5

While the benefits of radiation therapy for controlling breast cancer and improving survival are now well established,⁶ there is now a focus on how to limit potential side effects associated with radiation therapy and deliver more patient-centred care.^7-10

Breathing techniques to help protect the heart

One of the concerns with radiation therapy for breast cancer is the potential risk of damage to  organs near the breast(s) undergoing treatment – organs such as the heart and lungs can sometimes receive unintentional radiation that causes unwanted side effects or long-term complication.⁴ This is particularly significant for women receiving radiation to the left breast, as some radiation may reach the heart.^7,8

For patients undergoing radiation therapy for breast cancer, using a technique called deep inspiration breath hold can decrease the potential radiation dose to the heart.^7,8 The basis for this technique is that during a deep breath, the heart moves away from the chest wall.⁸ So, by holding a deep breath at certain moments while the radiation is administered – either following instructions from the radiation technicians monitoring their treatment or using a special device that helps to control their breathing – the heart is moved further away from the breast, which helps to protect it from radiation.^7,8

Moving towards tattoo-free radiation therapy for breast cancer

For some patients undergoing radiation therapy for breast cancer, the process of  treatment itself may involve unpleasant or negative experiences – including the use of permanent markings, or tattoos, on the body.⁹

Previously, it was common practice to place tattoos under the skin to help technicians correctly position a patient during their radiation therapy sessions. For the cancer survivor, however, these permanent marks often served as an unwanted and unavoidable reminder of what they had been through.^11,12

Studies investigating the emotional impact of these tattoos on women undergoing radiation therapy for breast cancer found that:^9,11

• 70% felt negatively about this change to their body
• 78% would have chosen a tattoo-free option if given the choice
• Women would have travelled an additional 72 km on average to be treated at a clinic using a tattoo-free technique
• Tattoos made women feel like they lacked choice and induced a feeling of disempowerment
• Tattoos were seen as a permanent reminder of the enormity of their illness

Overall, most women undergoing breast cancer radiation therapy involving permanent tattoos do not view these markings favourably.^9,11

Fortunately, healthcare providers are becoming more aware of the psychological and emotional impact these permanent markings can leave on a breast cancer survivor, leading more clinics to offer tattoo-free options for radiation therapy.^10,11

As proper body positioning is important to ensure radiation therapy is delivered to the right areas, studies have looked at the accuracy of tattoo-free positioning alternatives.^10,12 One such technique is known as surface-guided imaging, which uses multiple cameras to scan the 3D surface of a patient’s body.¹⁰ Not only has this technique has been shown to improve safety and comfort without compromising the accuracy of radiation therapy, it also does not require the use of permanent markings on the body.¹⁰

Women faced with the prospect of radiation therapy for breast cancer should know they have choices with their treatment, including when it comes to permanent markings on their bodies. While aspects of a breast cancer diagnosis and treatment may feel disempowering,⁹ the option of tattoo-free radiation therapy can help provide a sense of control and dignity for women on their breast cancer journey.

Disclaimer

Any medical procedure or treatment involving the use of radiation carries risks, including skin irritation and associated pain. Before proceeding with treatment, you should discuss the risks and benefits of the treatment with an appropriately qualified health practitioner. Individual treatment outcomes and experiences will vary. This information does not represent the outcome in your particular situation.