Deep-breath-hold radiotherapy for every suitable person with left-sided breast cancer

The guideline. NICE recommendation 1.13.2 in NG101 (2018) reads: "Use a deep inspiratory breath-hold radiotherapy technique for people with left-sided breast cancer to reduce the dose to the heart." The committee found no harms and no loss of target coverage, and found no evidence either way for right-sided cancer, so it made no recommendation there.

The measured gap. A 2015 survey of 82 radiotherapy departments in Germany, Austria and German-speaking Switzerland found that 90.2 per cent offered a heart-sparing technique, but 87.7 per cent used one in fewer than half of their breast cancer patients, and fewer than half (46.3 per cent) had written internal guidance. A survey of 50 of Australia's 69 radiotherapy centres in the same year concluded there may be less uptake of breath-hold there than in the international literature. A 2022 survey of 53 United States radiation oncologists found 90 per cent offered breath-hold and 74 per cent of those used it for at least a quarter of their breast patients; 32 per cent said they would be less likely to use it for a patient who did not speak English. No source OnCo found measures breath-hold use across the NHS.

What a reader can do: anyone having radiotherapy to the left breast or chest wall can ask whether breath-hold is planned for them and, if not, why not.