How different was training for massage in the 80’s versus today?
“When I was in school, teachers said we could not touch clients who had cancer. The idea at that time, and really up until 10 years ago, was that massaging the body would spread cancer. But there was a group of us who felt it was not true. So, in 1990, I held my first class, a mastectomy program, because my background as a nurse taught me how to handle cancer. In fact, my patients were my first teachers and I did not even know it.”

What is the best way for a therapist to approach a client with breast cancer?
“I would always first recommend that a therapist take a basic course in oncology massage because breast cancer is probably the most complicated cancer with which to deal. For example, because lymph nodes are removed from under the arm, not much can be done near that arm without causing possible lymphedema. Everyone is different. There are so many variables that the therapist has to weigh in on. This is why they need to have some training, even if it is very basic.
There are a few important questions that every therapist should ask a client with cancer. They should ask if the client has had one or more lymph nodes removed and where. It is usually under the arm. If the client indicates that they have, then the therapist should not massage that arm, unless they have been professionally trained. They should also inquire as to whether or not a client is receiving radiation. Women can receive massages during radiation therapy, but a therapist should not touch that area.”

Do you have any techniques or suggestions for the massage?
“Remember that there is absolutely no way that a massage therapist can spread cancer. The major considerations for anyone with cancer is the level of touch. Level one is very, very soft; level two is a little firmer and level three is firm without harm. Levels four and five are deep massages and are completely off limits to clients with cancer, as the main concern here is hepatic overload.
Levels one and two are great for clients in active treatment. I would only use level three in one area if they had a medical issue, such as sciatica, before they got cancer. Those issues do not go away just because they have cancer. If a therapist is going to use a level three to treat a separate issue, they should get written consent and possibly a script from a doctor, in case the client bruises.”

Are massages recommended for clients prior to a mastectomy or only post-surgery?
“Everyone with cancer should be getting touched. The term ‘massage’ can be misleading because most people think that it is about deep tissue work, but that is not necessarily all a massage therapist does. They go slow and pay attention to the client’s body. They are not fixing anything. So when it comes to a cancer client, comfort is important.
I always like to give two massages before surgery. The first massage is a level three or four to relax the muscles. The second one is a nurturing massage with some energy work (reiki or healing touch) for total relaxation. Clients who have massages before their surgery always have better postoperative outcomes than those who do not.
During the surgery, they are in a facedown position and their neck and back is very tight. It is not always about massaging the breasts, it is also about relaxing the rest of the body, the shoulders, and the back.”