Breast Cancer

Deodorant During Breast Radiation: Don’t Sweat It

Radiation treatment has the potential to cause brisk skin reactions through inflammation.  For breast cancer, underarm deodorant has been a theoretical concern for a worsened reaction.  I learned this bit of oncolore during residency – but in my opinion it’s wrong and makes treatment unnecessarily harder for patients.

Before and as treatment begins, nurses and doctors often advise breast cancer patients to avoid aluminum-based deodorants – which is most of them – or avoid them completely.  This is true also with putting creams or lotions on before radiation treatments, even if they are supposed to help the skin.

What’s the big deal? In breast cancer, the radiation skin reaction can be significant with redness, irritation, a rash, dry flaking or a more significant sunburn-like peeling reaction.  It can be painful and distressing.

The theoretical concerns are the following: deodorant and creams may be thicker on the skin; aluminum will increase radiation dose through scatter to the skin gets; or that absorption of aluminum or chemicals from the topical creams will lead to a worse skin reaction.  So putting these on the axilla (underarm) may worsen skin reactions.

These reasons simply don’t hold up under study.

1.  There is no significant increased skin dose with deodorants or lotions if well applied and absorbed.  A study done in 1997 showed that there is a maximum increased dose of 2.4% with deodorant, 0.3% with powder and 5.4% with lotions when placed on a polystyrene phantom.  The averages were 1.7% for deodorant and 2.4% for lotions on small fields – higher than would occur in actual treatment.  Metallic samples made no difference in dose.  If the topical agents were caked on, there were more significant increases but if reasonably well absorbed there is nothing that physics suggests increases the dose.

2.  Randomized trials don’t support any increased skin reaction.   Clinical trials have been done to evaluated deodorant use.  A 2009 study from Quebec randomized 84 women to a non-aluminum deodorant compared to none.  Women using deodorant had less sweating (18% vs 39%) and no difference in axillary reactions.  Another study from Calgary randomized 198 women with stage 0, I and II breast cancer to aluminum-based antiperspirant or none.  Again, no significant differences in skin reaction or quality of life.

 

DeodorantSource: Watson et al., 2012

Radiation oncology recommendations for skin care can make it more stressful for patients during treatment.  First, avoiding deodorant affects body image and odor.  One report confirms that over 60% of women worry about body odor when avoiding antiperspirants.  Who wants to go to work worried you may smell after getting zapped? Second, it adds an unnecessary stressor about when to use creams or lotions – if well absorbed, there should be no reason that women can’t apply them before radiation and not have to struggle to put it on at inconvenient times after treatment or later in the day.

Of course, we still don’t understand enough about who gets skin reactions, or why.  A clinical trial to identify potential genetic factors just closed recently.  There may be some women (and men) who do have a reaction because of aluminum exposure. We do try to reasonably lessen exposure to chemicals in perfumes or scented soaps.  During treatment, individualized decisions still are very important.

But for now, ask your doctor whether you really need to sweat it.

  • Todd

    The things I know about which have been studied and shown to decrease acute skin reactions for breast XRT patients are use of “IMRT” (strong evidence) and drinking one glass of red wine a day (single Italian study). Thanks Matthew.

  • Jmmrad

    Thank you for posting this! Not only waving away the myths and dogma of oncol ore, you introduce Evidence Based Medicine that supports common sense. I’ve been fighting this pervasive belief that skin cream should not be applied to patients receiving radiation treatment for years. The amount of cream needed to impact the skin would require millimeters, if not centimeters, of cream! Unless you’re using a spatula to place cream, ointments, or lotions on the skin, there is no need to worry.

  • Thanks for taking time to read and comment, Todd and Jmmrad. My hope is that there will be other areas where we can improve care.

  • Shane

    Sorry but …..”There is no significant increased skin dose with deodorants or lotions if well applied and absorbed. A study done in 1997 showed … increased dose of 2.4% with deodorant, 0.3% with powder and 5.4% with lotions when placed on a polystyrene phantom… if reasonably well absorbed there is nothing that physics suggests increases the dose”

    Herein lies some of the problems how we interpret evidence and why we shouldn’t discount historical practices as evidence (collected by ROs/RTs, on their patients, over many years in many countries – not oncolore) – the data given showed “no significant increases” (so there were increases but just not considered ((statistically)) significant – what is significant); the data given shows increases in dose (we don’t want any more dose – ALARA); “if reasonably well absorbed” (can we count on patients doing that instead of spraying large quantaties of deodorant and lotions repeatedly to cover issues, seen that many times); and “nothing that physics suggests increases the dose” (perhaps a limit on what physics can measure). There are many products that are PH neutral and show a positive benefit to skin care during RT. The future lies on doing better that the past. Sorry and thanks.

  • Thanks for your comments, Shane. You are right, the data above are imperfect. But it’s better than word of mouth. I do think there are favorable things we can do for skin care to lessen skin reactions. But that is a separate issue from creating unnecessary anxiety when randomized clinical trials show deodorant has no impact on skin reaction. Avoiding skin reactions also depends upon good patient education and awareness that maybe one patient WILL have a reaction. That requires listening, taking a good history and exam as patients go through treatment.

    I agree, the future does depend upon doing better than in the past. So let’s leave the myth of deodorant-related skin reactions in the past and find new areas for improvement in skin care.

  • Roger Gilbert

    Finally!

  • Moji

    Thank you Matthew for your information. My experience as a radiation therapist points in the direction of a more marked reaction when patients use cream just before treatment than not. Some patients have had a noticeably severe reaction that was not proportional to the dose received and later found to have been using cream before treatment.
    Additionally, I have found this severity evident in both white and black patients(worked in US and now working in Nigeria). A difference of 2% in severity of redness may be the difference between tolerating versus suspension of treatment for some patients, so why not let them avoid that by not using cream for a short while?
    I guess my personal experience is somewhere between EBM and “word of mouth”!

  • subatomicdoc

    Thanks for weighing in. It’s always great having a leader in the field contribute to the commentary 🙂

  • subatomicdoc

    As an update, a new study is being published with 333 breast cancer patients comparing no deodorant, aluminum deodorant and non-aluminum deodorant. No difference.

    http://www.redjournal.org/article/S0360-3016(14)03429-4/abstract