Deep Inspiration Breath Hold in Breast Cancer Treatment

Overview

What is a deep inspiration breath hold?

When you take a deep breath and hold it, your diaphragm (a large, dome-shaped muscle located at the base of the lungs) pulls your heart away from your chest. This is known as a deep inspiration breath hold (DIBH).

When is a deep inspiration breath hold used in breast cancer treatment?

If you are diagnosed with breast cancer, you and your doctor will develop a treatment plan. The type of treatment will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease.

One method of treating breast cancer is with radiation therapy, which uses high energy X-rays to kill cancer cells while minimizing damage to healthy cells. Radiation therapy is usually given after a lumpectomy (partial mastectomy) for one to six weeks to treat the remaining breast tissue.

Radiation is delivered to the affected breast and, in some cases, to the lymph nodes under the arm or above the collarbone. Most women who have a small, early-stage tumor are excellent candidates for this approach.

A potential problem with radiation therapy is that women who have cancer of the left breast may be at risk for heart disease from the radiation treatment. This is because the left breast is closer to the heart, which means it may be in the radiation field. (The lung may also be in the radiation field.)

If the heart receives radiation during breast cancer treatment, women may be at greater risk for coronary heart disease. This potential hazard may be further increased if a patient is also receiving chemotherapy at the same time, or if the woman is at higher risk for heart disease in the first place.

The overall likelihood of damage to the heart depends on several factors, including the radiation dose and how much of the heart is exposed to the radiation. This risk is present no matter the dose of radiation—even low doses.

Procedure Details

How does deep inspiration breath hold protect the heart?

One way to protect your heart while you are receiving radiation therapy is to hold your breath via DIBH. The radiation is then delivered to your breast while you are holding your breath deeply for 20 seconds. This will provide protection for your heart.

What this means in terms of radiation therapy for breast cancer is that you are moving your heart away from the “danger zone” of radiation. In fact, shifting the heart’s position in this fashion cuts the amount of radiation to the heart in half (compared to breathing normally).

There are commercial devices that can help you hold your breath during radiation treatment for breast cancer. These devices allow you to practice deep breathing before the radiation session, and will physically help you hold your breath.

You can also help prepare for DIBH during radiation treatment by practicing taking deep breaths and holding them at home, before your treatments. Studies have shown that practicing at home every day can help you improve your skills in DIBH.

If you want to learn more about DIBH, please ask your caregivers.

Last reviewed by a Cleveland Clinic medical professional on 01/07/2019.

References

  • Taylor CW, Kirby AM. Cardiac Side-effects From Breast Cancer Radiotherapy. Clinical Oncology, Volume 27, Issue 11, November 2015, Pages 621-629. https://doi.org/10.1016/j.clon.2015.06.007 (https://doi.org/10.1016/j.clon.2015.06.007)
  • Nissen HD, Appelt AL. Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiotherapy and Oncology 106 (2013) 28–32. https://doi.org/10.1016/j.radonc.2012.10.016 (https://doi.org/10.1016/j.radonc.2012.10.016)
  • Kim A, Kalet AM, Cao N, et al. Effects of Preparatory Coaching and Home Practice for Deep Inspiration Breath Hold on Cardiac Dose for Left Breast Radiation Therapy. Clinical Oncology 30 (2018) 571-577. https://doi.org/10.1016/j.clon.2018.04.009 (https://doi.org/10.1016/j.clon.2018.04.009)
  • Eldredge-Hindy H, Lockamy V, Crawford A, et al. Active Breathing Coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: Report of a prospective trial. Practical Radiation Oncology, Volume 5, Issue 1, January–February 2015, Pages 4-10. https://doi.org/10.1016/j.prro.2014.06.004 (https://doi.org/10.1016/j.prro.2014.06.004)

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