Tattoos are often seen as powerful expressions of individuality. In the medical world, however, they can serve as unwanted reminders of a difficult past.
For cancer patients requiring radiation therapy, permanent tattoos have long been necessary to help doctors accurately target and deliver treatment. Although seemingly insignificant, these permanent marks can remind many patients of their cancer journey every time they see themselves in the mirror. It’s time to put ink and needles in the rear view, because radiation therapy tattoos do more than just damage the skin; they can ruin the survival mentality.
The experience of breast cancer patients highlights the emotional toll these tattoos can take. Traditionally, these patients get between four and a dozen freckle-sized tattoos to accompany the radiation treatment.
“Not only do women suffer from knowledge of the disease, but they are also marked by memories of the experience through an increasingly outdated positioning technique,” one article said. explains. Tattoos can help radiation therapists with positioning, but are a “constant reminder of this disease and the patient’s treatment and battle against it.”
This isn’t true for everyone: some see their tattoos as a sign of resilience and even expand them into larger, meaningful designs. In a UK based company questionnaire among breast cancer survivors, 59% of respondents who could see the tattoos on their sternum after cancer treatment were “never bothered” by them.
However, the same survey found that 27% of participants viewed the tattoos negatively, and 14% of respondents said the tattoos influenced their choice of clothing. Other reports are even more striking; A questionnaire by young women diagnosed with breast cancer before the age of 40 found that around 60% of women had ‘negative’ or ‘very negative’ feelings towards getting a tattoo as part of the treatment, with 78% of women interviewed stating that they would choose a treatment that involved tattoos and/or marks would be avoided even if additional efforts were made. were necessary, such as extra costs, extra distance or travel time.
In addition to the emotional impact, tattoos can also lead to physical complications. Some patients experience allergic reactions, dermatoses, keloids, infections and even permanent scars. Tattoo removal may be an option: the American Society for Laser Medicine and Surgery even has one program in which volunteers remove free radiotherapy tattoos from patients who have undergone radiation treatment for any form of cancer, highlighting the need for a more individualized approach.
But increasingly there is an alternative to tattooing, namely surface-guided radiotherapy (SGRT).
SGRT uses a three-dimensional camera to accurately track body movements in real time, including subtle shifts such as breathing movements, without the need for tattooing. This allows for incredibly precise treatment delivery, with treatments automatically paused if the patient exceeds a set threshold.
Our healthcare system began phasing out radiation therapy tattoos in 2019. Although we were the first group to treat breast cancer patients tattoo/marker-free, we expanded our vision to other anatomical locations after witnessing its positive impact firsthand. Some patients come in and are pleasantly surprised that they don’t need the tattoos their parents or older siblings got. Others, including men with prostate cancer, have deliberately sought out facilities to prevent tattoo marks.
Increased familiarity with the technology allows us to omit markings on the head, neck, chest, back, abdomen, pelvis or limbs. This gives patients the freedom to choose their swimwear, evening wear and everything in between, without having to worry about covering up unwanted tattoos. Children with childhood cancer experience no additional discomfort and do not have permanent, involuntary body changes that follow them into adulthood.
Wider adoption of SGRT is not without challenges. The technology requires a financial capital investment and specialized training for healthcare professionals, as well as a fundamental change in mindset.
Tattoo removal also improves clinic safety for both patients and staff, eliminating the risk of accidental needle sticks. Sharps containers are emptied less often and tattoo equipment is no longer purchased, gradually creating cost savings for the department. We believe that the long-term benefits to patients and staff, both physical and emotional, far outweigh the initial costs.
Others are starting to get it. Although we were the first in the New York metro area to go completely tattoo/marking free, there are a growing number of facilities across the country and the world who now offer the same.
As healthcare providers, our commitment to patient-centered care forces us to continually look for ways to improve cancer treatment. By embracing innovation and challenging outdated practices, we are creating a new paradigm for radiotherapy, one where technology and compassion come together to deliver the highest quality care and quality of life.
William Chun-Ying ChenMD, is vice chairman for quality and safety of radiation medicine at Northwell Health and an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. Louis PottersMD, is deputy chief medical officer of the Northwell Cancer Institute, and professor and chairman of the department of radiation medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.