Invisible Tattoos vs Black Ink Tattoos in Radiation Therapy

A woman undergoes breast cancer radiation therapy.
A woman undergoes breast cancer radiation therapy. Mark Kostich/Getty Images

Tattooing is a necessary part of the radiation process. It functions as a guide that helps the radiation technician line up the treatment fields the same way each time for every treatment.

Permanent ink tattoos are the current standard practice of targeting radiation therapy over a course of many treatments. Tattooing methods usually involve using freehand needle sticks and permanent black ink. Markings are done with a very small needle and a drop of ink. Some women describe the procedure as feeling like a small pinch, or an insect bite. Tattoo markings are often described as having the appearance of a dark freckle.

Seventeen years after radiation therapy following a lumpectomy for an early breast cancer, the permanent black ink tattoos marking the corners of my treatment areas are still quite visible. They appear as small, black dots, too black to be considered healthy freckles. I don’t really notice them anymore, but I remember when that was not the case. When they were new, and my cancer memories fresher than I wanted them to be, seeing tattoos was a painful reminder. My permanent tattoos caused me to rethink swimwear and make clothing choices that covered them from view.

Until recently, my question has been, “Does the tattooing have to be done with permanent black ink that leaves women with unattractive, forever after reminders of their breast cancer experience?” Then I came across a report on the results of a pilot study on fluorescent tattoos as an alternative to using permanent black ink. The study is the first to clinically test the effectiveness of fluorescent tattoos (invisible tattoos) in radiation therapy, as well as demonstrating the cosmetic value for patients in using invisible tattoos in place of permanent dark ink tattoos.   

Research study results, which were presented at the National Cancer Research Institute (NCRI) Cancer Conference, suggest that the permanent ink marks made on the skin of women having radiation therapy keeps reminding them of their diagnosis for years after treatment.These permanent reminders tend to impact on self-esteem and detract from a woman’s self image. Also, it is often more difficult to spot black ink tattoos in dark-skinned women, which may lead to treatment issues.

The National Institute for Health Research funded researchers, based at the Royal Marsden Hospital in London, to speak with 42 breast cancer patients undergoing radiation therapy to assess how they felt about their body, before beginning treatment and one month later. Half the women received fluorescent tattoos, only visible under UV light, while the other half were given the standard dark ink tattoos.

Findings demonstrated that 56% of the women who received the fluorescent tattoos felt better about their bodies one month after treatment, while only 14 % of the women who received the black ink tattoos felt better about their bodies. Using fluorescent tattoos also made no difference in the accuracy of treatment, and took only slightly longer to carry out, compared to conventional dark ink tattoos. Fluorescent tattoos could be seen in all the patients who received them. No one reported any ill effects from the fluorescent tattoos.

Steven Landeg, a senior radiographer from the Royal Marsden, presented the data at the conference. He reported, “These findings suggest that offering fluorescent radiotherapy tattoos as an alternative to dark ink ones could help ameliorate the negative feelings some women feel towards their bodies after treatment. It’s important to remember that body image is subjective and dark ink radiotherapy tattoos will affect patients differently, but we hope that these results will go some way towards making this a viable option for radiotherapy patients in the future.”

One of the women who took part in the study shared that there wasn’t a mark on her skin after the procedure.  

Professor Matt Seymour, NCRI’s clinical research director, said, “With more than half of all cancer patients now surviving 10 years and beyond, it’s imperative that we do everything we can to reduce the long term impact of treatment on patients, including cosmetic changes.” The study was funded by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research (ICR).