Everyone who’s finished their breast cancer treatment should have their arm movement and chest scar tissue assessed.
Assessment after cancer treatment is completed is a minimum recommendation- in some USA cancer certified clinics they are looking at providing pre- surgery assessment.
An example of current rehab practice in Australia
My client had a lumpectomy, had all her nodes at the axilla removed and then had 30 sessions of radiotherapy. Yesterday, which was about 4 years after surgery, was the first time that someone had assessed the severity of her scar tissue from these interventions, even though she'd seen a therapist for treatment for her arm lymphoedema.
After her first session she said “Everyone should have an assessment of their scar tissue”.
I whole hearted agree!
Why must people put up with tightness at the chest or breast?
Women are working during and after their breast cancer; how do we expect them to cope both physically and mentally when their body is not functioning at it's best?
This raises three important issues:
1. There is enough research to support the implementation of early assessment and treatment of problematic scar tissue especially after mastectomy, cording and radiotherapy (axilla).
2. There continues to be poor referral by Doctors: people with movement restrictions and even pain are rarely referred to specialist rehab service providers.
3. Lymphoedema therapists may not have learned the skills to assess or treat breast cancer surgery and radiotherapy scar tissue; problematic scar tissue can be missed.
What does this mean?
The short answer is: people after breast cancer need to take action and ask for a referral to a breast cancer rehab health professional, especially if there is any restriction in the freedom of movement in the same side arm and definitely if non cancer pain is occurring at the chest or shoulder.
The longer answer is that many cancer care clinics may not have a list of trained service providers with these skills or people may not be seeing their breast surgeon or attending their breast cancer clinic. This means that individuals need to search for a health professional who knows how to assess and treat the common problems that slow or restrict arm movement.
How can problematic scar tissue be missed or misunderstood?
This same lady I saw yesterday is a researcher at a nearby University, doing her PHD on the impact of shift work on health and wellness – so she is knowledgeable about health.
Yet, she had no idea that the removal of her nodes resulted in much deeper scarring which was causing some discomfort and stiffness in her arm movements.
“My armpit scar looks great but I was never told that this scar was not where the nodes were removed.
I had no idea that it could be deep chest scar tissue affecting my arm movement”
Axilla nodes are located more towards the mid upper rib cage- at the base of pec minor muscle. This means that during the healing phase scar tissue can form between the pec minor muscle and the pec major muscle and so they adhere together – making arm range of movement less and stiff.
Cording is another example of where tissues in this area, in this case lymphatic vessels, can also get adhered to the muscles and breast tissue at the mid upper chest.
Does everyone have problematic scar tissue after surgery and radiotherapy?
The stats are variable, but consistent: about 50% of people in study groups across the world have one or more persistent arm symptoms.
Yes, that’s 1 in 2 people!
That’s common, not uncommon.
Is referral to breast cancer rehabilitation health professionals improving?
In Australia – I don’t see this happening in many cancer clinics yet.
In USA, health insurance agencies have mandated that rehabilitation plans are created and carried out - covering all side effects, not just scar problems.
What to do?
We can all wait for referral pathways for managing side effects to improve.
BUT there is something you can do right now.
I help you with a scar and arm movement assessment?
If you live in or near Brisbane, then it will take only 45 mins to have your assessment and first treatment. In the first treatment you will know if you get improvements because we use Reach-out-the-back Test. ROTB is a test I designed because the usual test methods aren't good enough to detect what you are feeling, especially when the scars are deep.
Not in Brisbane, but wondering how you can get an assessment, and commence treatment if needed, given COVID travel restrictions?
Then connect with Denise Stewart to book an online consult. It’s the same, but slightly different: it takes 45 mins but you start taking action on your arm movement issues with my guidance.
Use the contact form at the top right of this page; let me know where you live, so I can target my response to you.
Want to know more about what self- treatment looks like?
Ive put my assessment and treatments into bite size sessions- there are plenty of ideas here.