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3 Things About Breast Cancer Treatment That Really Annoy Me

Being diagnosed with breast cancer is hard enough. A patient is faced with navigating an entirely new world of doctors, surgery, radiation, and chemotherapy, not to mention having to face the fear that comes with the diagnosis. During my time treating breast cancer patients and also having had people close to me go through treatment I have noticed a few things that particularly annoy me. I started wondering if there might be alternatives to some of the ways we approach breast cancer treatment. I listened to my patients as they investigated, talked with other patients and told me about alternative approaches. Over the past year, 3 things have come up consistently.

The first is the radiation dot. Radiation dots are small, dark, permanent ink dots placed on a patient’s chest to mark the area for the radiation oncologist to radiate. These are permanent reminders of diagnosis and treatment and are in plain view in a low cut dress or bikini.

 

 

Someone close to me going through radiation asked – “why can’t they just use a permanent marker and re-mark it every time it starts to fade?” I thought this was a pretty reasonable question and it turns out there are some alternatives. The first is use of a Jiffy marker pen to place the dot and then a waterproof dressing called Tegaderm to protect the dot when the patient showers. A second option is fluorescent tattoos that are only visible under a certain type of light (UV). Steven Landeg and colleagues in London tried this and then studied 46-patients in a randomized fashion comparing traditional black tattoos with the new invisible one. They found this technique to be safe and it did not impair the radiologist’s ability to deliver radiation. Read more about the study here. Alternatively, if you already have a radiation dot Dr Gerald Boey at Arbutus Laser Center will remove it for free for cancer survivors, which is pretty awesome.

Another thing about breast cancer treatment that I don’t like is the permanent change in skin color you can see on the chest after radiation. The skin will blister and desquamate during radiation and in many patients this leaves a permanent dark shadow on the chest. You can see it on the patient above (right side) and below:

 

 

It turns out there might be something that can help with this as well. Researchers in New Zealand have started using Mepitel Film to cover the area that is being radiated and have found that overall skin reaction severity was reduced by 92% when using Mepitel Film. This may decrease the amount of pigmentation left behind after radiation. The researchers have also found that it does not affect the ability to administer the radiation. Take a look at their study here and here is a link to the actual product.

The third thing that annoys everyone is hair loss. Because the chemotherapy drugs target cells that multiply quickly (i.e. cancer cells) the drugs can also kill good cells that multiply quickly (i.e. hair follicle cells). This can lead to loss of hair on the head, eyebrows and eyelashes. One company in Dallas has come up with a potential solution. The company, Chemo Cold Caps produces a scalp cooling system that comes in the form of tightly fitting, strap-on, helmet-type hats filled with a gel coolant that’s chilled to between -15 to -40 degrees Fahrenheit. This causes vasoconstriction of the blood vessels of the scalp, which reduces the amount of chemotherapy drugs reaching the hair cells. Cooling also slows down cell division which may decrease the number of cells targeted by the chemotherapy drugs. The system is quite involved but it sounds like it might be worth it. One of my patients is going through this right now and I will provide an update when she is done as to whether it worked for her.

 

 

And I’ll keep listening and update you with new techniques as I hear about them!

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Opportunity begets opportunity

Some of you may remember my post from a couple of years ago about a patient who requested a surgical technique (DIEP+Implant) that I had no experience with. She sought a second opinion and as luck would have it that surgeon happened to love our city of Vancouver. He generously offered to come to Vancouver to instruct me on the technique during the operation. I saw this as a great opportunity to learn from one of North America’s best breast reconstruction surgeons (Dr Scott Sullivan).

Dr Scott Sullivan, Patient, Dr Sheina Macadam March 2015

 

Dr Sheina Macadam, Dr Scott Sullivan March 2015

 

The surgery was successful and as a bonus I got to spend a few days speaking with Dr Sullivan and showing him around Vancouver. He created the Center for Restorative Breast Surgery in New Orleans, which was expanded after hurricane Katrina to include eight operating rooms and enough patient rooms to house over 20 inpatients. The surgeons at this center perform breast surgery exclusively and have become innovators in the field of breast reconstruction. I got to thinking that it might be a good idea to go down to New Orleans and see what else I could learn.

Last month I booked a ticket and after finding out that Vinnie Myers also works at the CRBS I decided to bring my tattoo artist Leah along as well. Vinnie originally started as a tattoo artist and gradually added 3D nipple areolar tattooing to his repertoire. He is now famous for his nipple tattoos which are some of the best I have ever seen. His young daughter has recently taken up his craft and is training as an apprentice. We got to meet both Vinnie and Anna while we were there.

While I was there I observed Dr Sullivan and some of his partners perform procedures that have given me a new outlook on how to use my skills. This team is truly pushing the boundaries of excellence to create better and better options for our patients. They are also an example of innovation at the crossroads of specialties – for example Dr Sullivan was the first to combine the standard DIEP technique with laparscopic technique to spare even more muscle and fascia, giving patients less chance of problems with their abdomen after surgery. I was so inspired by their work, but also the vision and passion behind building this center of excellence.

 

 

Dr Scott Sullivan, Dr Sheina Macadam April 2017

 

I feel very lucky that the opportunity to work with Dr Sullivan literally dropped in my lap. It forged a friendship that has led to this most recent opportunity, and also the chance to collaborate on an article that I wrote on breast reconstruction for our journal Plastic and Reconstructive Surgery. We also had time for a little entertainment including a dinner out and some sight-seeing. All in all an awesome opportunity!

Anna Myers, Dr Sheina Macadam,Vinnie Myers, Leah Grandmaison,                             Dr Michele Cooper, Dr Scott Sullivan

 

Leah Grandmaison, Dr Sheina Macadam on Bourbon St.

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