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Breast Cancer & Fitness to Dive Issues

DAN looks at treatments and discusses breast implants.I am 40 years old, an avid diver and in excellent health, but I have just been diagnosed with breast cancer. I am looking at various treatments, including the possibility of future reconstructive breast implants. How will breast cancer treatments and breast implants affect my fitness to dive?

Next to skin cancer, breast cancer is the second-most diagnosed cancer in American women.

One out of every three cancers diagnosed for women is breast cancer; estimates in 2003 eclipsed 210,000 cases. From 1996 to 2000, 94 percent of all new cases of breast cancer occurred in women 40 and older. Manual self-examinations, periodic mammograms and better therapy options are contributing factors believed to be partially responsible for improving survival statistics.

Treatment decisions are based on the stage of the cancer and its location, the age and health of the patient and the risk and benefit of each option. No treatment is simple, but the easiest is a simple surgical removal of the mass. To control the risk of the cancer spreading (metastasis), some cases may require the removal of all breast tissue and surrounding lymph nodes (mastectomy). The surgical procedure is not the major concern for diving. Once an incision heals and the diver returns to normal activity with no risk of infection, the diver is released for full activity.

The prime concern for scuba divers is the effect of drugs and / or other therapies in the treatment of cancers. It is frequently necessary to use radiation and / or systemic chemotherapy treatment to attack rapidly growing cancerous cells. For example, chemotherapy drug doxorubin (Adriamycin®), if combined with hyperbaric oxygen therapy, may increase the risk of cardiac toxicity. Another chemo drug, methotrexate, has an increased risk of pulmonary toxicity, and cyclophosphamide (Cytoxan®) has a possible adverse reaction of formation of scar tissue (pulmonary fibrosis).

After treatment, and before resuming diving, a woman's lungs should be evaluated for any damage that may increase her risk for a lung expansion injury (pulmonary barotrauma) while diving. Cytotoxic drugs (chemotherapy) and radiation can cause nausea and vomiting, but they are still a valuable part of the arsenal in the war against cancer. Avoid diving during cancer therapy. During treatment, the potential for side effects is greatest.

The central risk for divers is breathing compressed gas. Since not all tumors are the same and reactions to treatment vary, not every diver can return to scuba after breast cancer. Loss of flexibility and strength in lung tissue increases the risk of lung injury, especially a collapsed lung (pneumothorax). A pneumothorax while diving could be fatal and not worth the risk of diving.

If their lung functioning is appropriate and they are otherwise fit and healthy, many women do return to diving after breast cancer. Because post-surgical scarring may cause a restriction in the range of motion of the affected arm, intensive physical therapy may be needed to get the diver back to a normal activity level for diving.

Are Breast Implants an Issue?

Saline-filled breast implants are neutrally buoyant. Silicone implants are negatively buoyant and may therefore to some degree affect buoyancy and trim. Constrictive chest straps or buoyancy compensators may cause irritation and discomfort around the surgical area or on the implants and should therefore be avoided. Breast implants are not a contraindication to diving and should not pose undue risk.

Will Retention of Fluid (Lymph Edema) Be a Problem?

Drinking too much water does not cause lymph edema or swelling. (Note: One must continue to properly hydrate during a dive trip.) Fluid retention can occur, however, because the lymphatic drainage of the arm passes through the armpit (axilla), and the tissue there has been removed during mastectomy.

The lymph channels and ducts help transport the protein-rich fluid known as lymph throughout the body. The lymphatic system moves this fluid from tissues to the blood system, and it produces disease-fighting white blood cells as part of the body's immune system.

The swelling in the arm may require a pressure garment to help deal with fluid in the tissue. Women have reported that it doesn't bother them or might even be a little better after several days of diving. Diving with any degree of impairment should be reason to dive more conservatively and avoid dives of long duration.

What's Next?

In general, someone can enjoy scuba diving after breast cancer treatment. In some cases, chemotherapy drugs of greater potency will cause toxic effects, with too much damage to allow further diving.

The wait to return to diving for those who can and wish to continue diving may be long. Don't underestimate the time required for rebuilding the strength and endurance needed to dive safely. If a diver can't react to sea conditions such as current, surge, or a swim back to the boat or to shore, she may be putting herself or her dive buddy at undue risk.