SATURDAY, Nov. 24, 2001 (HealthDayNews) -- For a small but growing number of women who have successfully fought breast cancer, the battle doesn't end with the last radiation treatment.
They are turning to laser surgery to erase some of their radiation tattoos -- the "bull's eyes" used by oncologists to outline the area of the chest being treated with radiation.
And while the trend has triggered debate among cancer specialists, some doctors are giving their patients permission to proceed with the procedure, but only if the cancer was detected early and the chances of recurrence are slight.
The women cite two main, though very different, reasons for having tattoos removed.
The first is cosmetic: Some women find that tattoos that are visible above a low-cut dress or bathing suit, for instance, are unsightly. (The tattoos are about 1 millimeter in size.) The second is psychological: To some patients, the tattoos are a painful reminder of a terrible ordeal.
"Not for every patient, not in every situation, and not every tattoo should be removed," says Dr. Theodore Lo, a radiation oncologist at the Lahey Clinic in Burlington, Mass. "But if the tattoo is in a cosmetically important place and it will not be used again, you can permit laser surgery to remove it."
Lo has allowed about 100 women in the last 18 months to have tattoos -- almost always the one above the breast -- removed by laser surgery. Many of these women are younger, in their 40s and early 50s, and had their cancer diagnosed in very early phases so the risk of recurrence is extremely low.
"Mammograms are so sensitive that a lot of younger women are getting early diagnoses, where the cure rate is 97 percent, and they are having lumpectomies," he says. "Who wants to walk around in a bathing suit with a black dot showing?"
Tattoos, usually between three and five, are placed above the breast, between the breasts, and below the breast as a guide for the radiation oncologist.
The reason for keeping the remaining tattoos is that if breast cancer strikes the other breast, a woman won't have the same tissue re-radiated, which can cause thickening of the skin and scarring.
"The middle dot is the most important because if cancer is found in the other breast, you need to match radiation therapy to the adjacent area," Lo says. "But it is the upper dot that shows when wearing a low-cut dress -- some people looking at that tattoo will know you have breast cancer -- and that's the one where you can permit laser surgery to remove it."
There are no statistics on how many women choose to have radiation tattoos removed, says James Deye, a research scientist with the National Cancer Institute.
"It's one of those technical questions that's between a patient and her doctor," he says.
But Lo adds, "Most women don't know the procedure is available. When they do, they think it's a good idea."
Not all cancer specialists share Lo's views, however.
Some doctors say it's dangerous to remove any of the tattoos. Doing so raises the risk of overlapping radiation treatments, they say.
Dr. Peter B. Schiff, chairman of radiation oncology at Columbia Presbyterian Medical Center in New York City, endorses a conservative approach.
He says that in cases of non-invasive breast cancer, like ductal carcinoma in situ, where the cancer has not spread into the fatty tissues of the breast, removing the most visible tattoos would be a possibility.
"For those women who have a very low risk, it wouldn't be unreasonable to consider removing the tattoos," Schiff says.
"However," he says, "for those with invasive breast cancer, with a different risk of recurrence, those women should not have their tattoos removed," he says.
What To Do
The advisability of removing tattoos after completing radiation therapy for breast cancer depends on your diagnosis and health, so you shouldn't consider laser surgery without consulting your oncologist.
To learn more about breast cancer, visit this American Cancer Society Web site. For information about the decline in deaths from cancer, including breast cancer, during the 1990s, go to this National Institutes of Health site.
