Talking about breast cancer can be a tough topic. All genders can experience breast cancer. It is the most common cancer in women in Australia, with 1 in 7 women diagnosed in their lifetime. While not as common, men also experience breast cancer with 1 in 500 men receiving a diagnosis in their lifetime (National Breast Cancer Foundation,2023). This means that many of us will have been touched by breast cancer in knowing someone who has received a diagnosis or having one ourselves.
A diagnosis of breast cancer and then the journey of treatment can be overwhelming. Breast Cancer Awareness Month works to raise awareness and funds for research as well as support networks and organisations that can help family, friends, and health professionals to support their loved ones or clients on their individual journeys.
The overall 5-year survival rate according to Australian statistics for those that have breast cancer is now reported to be 92% and 86% for the 10-year survival rate. Early detection and diagnosis can make a significant impact with a 100% 5-year survival rate for those diagnosed with early stage 1 breast cancer (National Breast Cancer Foundation, 2023). The increase in survivorship and life after a cancer diagnosis and treatment also brings new challenges.
To get a better insight into how dermal health professionals can support those with breast cancer we meet two dermal clinicians who tell their stories. Dora and Diane provide inspiration for how you can use your knowledge and skills or gain further education and expertise to support those with breast cancer and make a difference in the breast cancer survivorship journey.
Dora’s Story: My personal journey with breast cancer and beyond.
Breast cancer awareness month strikes a personal chord with me as not only did l witness my mum navigate her experience of breast cancer 10 years ago, but l too, had my own journey when l was diagnosed with DCIS (ductal carcinoma in situ) 6 years ago. I have a strong family history of breast cancer so perhaps it wasn’t entirely surprising that my genes caught up with me but nevertheless, it was still a shock. It provided me with a sense of awareness of what many women and men potentially experience emotionally and physically upon a diagnosis of breast cancer.
Mum and l were fortunate that we were diagnosed early but we both had a lumpectomy and had to undergo radiotherapy treatments. Prior to commencing a course of radiotherapy treatments, time is spent with a radiation nurse who discusses the treatment, the potential side effects and the management of these side effects including the skin changes that one can experience.
As a Dermal Clinician, l was at an advantage in understanding skin but did my due diligence and researched in depth exactly what happens to the skin during and after a course of treatments to gain a greater understanding of the grading of radiation-induced skin reactions. Evidence suggests that skin reactions from radiotherapy treatments cannot be avoided, hence management of these skin reactions is vital.
My journey as a Dermal Clinician during my time as a patient of breast cancer as well as for my mum was mainly focused on the management of skin changes. However, due to the complexities of breast cancer journeys that can be different from patient to patient, treatment interventions can vary considerably during or after.
Diane’s Story – Providing support and closure to those with breast cancer.
Breast cancer awareness month reminds me how incredibly strong these women are and what they have survived! Since 2016 I have been honoured to help these women through their breast cancer journey providing them with some closure. Offering areola and nipple tattooing to help them when they look in the mirror gives them some comfort by not constantly reminding them what they have gone through. I get tears after it’s completed, I receive gratitude and incredible messages of thanks. Some say they have only booked their tattoo because their surgeon suggested it, but after they get it done, they cry not realizing the impact it has had on them and the difference it makes.
When I started my career in this field, I was fortunate to work with one of Victoria’s top surgeons specialising in breast reconstruction surgery in both public hospitals and privately. He supported creating a position at Western Health [in Melbourne] for reconstructive tattooing. This involved collaboration with the Breast Cancer Foundation which assists breast cancer patients financially to have their tattoos done. From there one of my colleagues, a theatre nurse, linked me with another surgeon who is a leading expert in Australia providing surgery for lymphoedema and lipoedema patients.
(image permission provided restore_cosmetic_tattooing)
What skills do dermal clinicians have that can support skin health during breast cancer treatment?
According to Diane, Dermal Clinicians have a lot to offer to those diagnosed and undergoing treatment for breast cancer. She says that skin care advice and management in particular is a big one!
Their skin changes so much. Whether this is from radiation and/orchemotherapy they can experience major skin changes, including pigment changes, loss of moisture, dryness, and skin texture changes.
Dora provides further insight that if the management of radiation-induced skin changes is what a Dermal Clinician would like to be involved in they need to consider interprofessional collaboration.
We would need to work alongside the patient’s medical team including their radiation nurse in supporting them in working towards the goals of care in skin care.
These can include, maintaining the integrity of the skin, minimising treatment-induced symptoms, supporting patients with self-care interventions such as maintaining cleanliness, providing correct management for patients to prevent further trauma, pain, and possible infection as well as promoting a moist wound healing environment.
Diane explains that the knowledge and skills of dermal clinicians can also be of benefit after surgery particularly as they can be left with significant scars.
We offer scar management which can be as simple as recommending silicone gel or dressings after surgery or to help improve their scar. Furthermore, laser therapy may be used to improve the appearance of their scars.
Lymphoedema is something that 20% or 1 in 5 people with breast cancer can experience after surgery as well as during or after radiation therapy (Australian Government, Cancer Australia, 2023).
Diane explains:
Educating these patients early on is key to help them with early detection and knowing the signs to look for as well as small techniques to help them.
We can teach them self-manual lymphatic drainage, discuss the use of garments and compression, and what signs to look for indicating changes in the skin. We can also offer these patients manual lymphatic drainage professionally in the clinic, LED treatments and low-level laser therapy may be helpful.
In Diane’s experience, she says, that when they [patients] see differences it can also have a snowball effect motivating them to recommend our services to others experiencing this journey as well.
If Dermal health professionals want to work in this area what further education and training or personal attributes do, they need to consider?
Dora provides this important advice:
Regardless of whatever one chooses; the greatest consideration is that our approach must always be evidence-based and therefore ongoing education and training is vital.
Diane expands on this to reiterate that if they want to work specifically with breast cancer patients they should get more training in lymphoedema assessment and treatment. To do this they should also consider undertaking an accreditation qualification course, recognised by the Australasian Lymphology Association (ALA).
Besides the practical skills, Diane says dermal clinicians need to have a high level of emotional intelligence and empathy.
We need to consider the emotions of these patients. These patients are going through a stressful time of survival, and we need to be aware of this and be very supportive. How we communicate is vital. Some [patients] have gone through multiple surgeries; their bodies have changed significantly, and it’s a major impact on their life.
Diane also provides advice regarding the importance of making connections and networking. Diane recommends signing up with companies like garment and compression companies that send newsletters as they can also provide webinars and workshops to attend.
Networking in our industry is so important. Attending any related conferences is such an important way for us to be recognised, and meet other professionals who work with cancer patients, for example, nurses and physiotherapists. You can get an insight of what others experience and bounce ideas amongst each other as well as learning through their experiences and troubleshooting.
I also highly recommend volunteering at a plastic surgery clinic that specialize in breast cancer, that’s how I started my career in this field and they may even link with us to assist with job opportunities in the future
We thank Dora and Diane for sharing their valuable insights and pearls of wisdom on this topic with all dermal health professionals. Continue to follow the Australian Society of Dermal Clinicians this month as we focus on updates in best practices, skin health advice, and management for those with breast cancer.
Contributors
Dora - Dermal Clinician
Diane Camilleri - Dermal Clinician and owner of Restore Cosmetic Tattooing
Disclaimer
The information in this document is of a general nature only and is not, and is not intended to be advice. Before making any decision or taking any action, you should consult with appropriate accounting, tax, legal or other advisors. No warranty is given as to the correctness of the information contained in this publication, or of its suitability for use by you. To the fullest extent permitted by law, the Australian Society of Dermal Clinicians Inc. (ASDC) is not liable for any statement or opinion, or for any error or omission contained in this publication and disclaims all warranties with regard to the information contained in it, including, without limitation, all implied warranties of merchantability and fitness for a particular purpose. ASDC is not liable for any direct, indirect, special or consequential losses or damages of any kind, or loss of profit, loss or corruption of data, business interruption or indirect costs, arising out of or in connection with the use of this publication or the information contained in it, whether such loss or damage arises in contract, negligence, tort, under statute, or otherwise
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