Many healthcare providers are not fully aware of the potential benefits of massage or may have concerns about its risks. Consequently, barriers to access are sometimes created. For years, massage therapy has been thought to initiate or accelerate cancer metastases in patients with cancer (Walton, 2000). Likewise, many massage therapists are concerned that massage—or even touch— will release cancer cells from a primary tumor (MacDonald, 1999). A common myth that many patients and healthcare providers believe is that women with breast cancer who have undergone breast surgery with lymph node dissection cannot receive massage therapy (Chapman & Kennedy, 2000). These women can safely receive massage therapy; however, massage therapy from a LMT with specific training in the massage of patients with breast cancer is recommended. The length, depth, and speed of the massage must be adjusted for patients receiving breast cancer treatment (Chapman & Kennedy). Also, if the patient has lymphedema secondary to axillary node dissection, specific therapy for lymphedema should be used as a separate modality or treatment. Another concern is that massage therapy will promote cancer metastases. Metastases occur in three stages. Cancer cells are shed from the primary tumor, these cells travel via the blood or lymph channels, and the cells then settle in a secondary site. Theoretically, massage therapy applied locally and with sufficient intensity could aggravate cell shedding, especially if applied to a superficial tumor (Curties, 2000). Leaders in massage therapy are developing new guidelines that will outline the educational preparation, clinical skills, and critical thinking needed to work with patients with cancer (Walton, 2000). Despite this, many massage therapists still rely on a physician’s order or note that contains directions for the therapy and permission to treat patients with cancer. The factors that a massage therapist considers in determining what technique can be used safely and effectively for a patient with cancer are tumor location, cancer stage, and location of any metastatic site(s). Walton reported that having knowledge about cancer and metastatic patterns is very important for a massage therapist treating a patient with cancer. LMTs need to know to avoid local and regional pressure in the area of the tumor and that the cause of any pain or discomfort must be determined before massage therapy may resume. LMTs also must have an understanding of the types of cancer treatment and potential side effects before beginning a treatment session (Walton)