Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions

Hoda E. Sayegh, Maria S. Asdourian, Meyha N. Swaroop, Cheryl L. Brunelle, Melissa N. Skolny, Laura Salama & Alphonse G. Taghian. Curr Breast Cancer Rep (2017) 9:111–121

Click to read the abstract

Abstract

Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions

Hoda E. Sayegh, Maria S. Asdourian, Meyha N. Swaroop, Cheryl L. Brunelle, Melissa N. Skolny, Laura Salama & Alphonse G. Taghian. Curr Breast Cancer Rep (2017) 9:111–121

Purpose of Review

Breast cancer-related lymphedema (BCRL) is a chronic, adverse, and much feared complication of breast cancer treatment, which affects approximately 20% of patients following breast cancer treatment. BCRL has a tremendous impact on breast cancer survivors, including physical impairments and significant psychological consequences. The intent of this review is to discuss recent studies and analyses regarding the risk factors, diagnosis, prevention through early screening and intervention, and management of BCRL.

Recent Findings

Highly-evidenced risk factors for BCRL include axillary lymph node dissection, lack of reconstruction, radiation to the lymph nodes, high BMI at diagnosis, weight fluctuations during and after treatment, subclinical edema within and beyond 3months after surgery, and cellulitis in the at-risk arm. Avoidance of potential risk factors can serve as a method of prevention. Through establishing a screening program by which breast cancer patients are measured pre-operatively and at follow-ups, are objectively assessed through a weight adjusted analysis, and are clinically assessed for signs and symptoms, BCRL can be tracked accurately and treated effectively. Management of BCRL is done by a trained professional, with research mounting towards the use of compression bandaging as a first line intervention against BCRL. Finally, exercise is safe for breast cancer patients with and without BCRL and does not incite or exacerbate symptoms of BCRL.

Summary

Recent research has shed light on BCRL risk factors, diagnosis, prevention, and management. We hope that education on these aspects of BCRL will promote an informed, consistent approach and encourage additional research in this field to improve patient outcomes and quality of life in breast cancer survivors.

Main findings

  • This paper reviewed the literature in regards to diagnosis of BCRL via various forms of measurement. The key findings were diagnosis of BCRL should not be made by only volumetry and bioimpedance but clinical examination as well as a subjective assessment is essential.
  • Risk factors for lymphoedema included:
    • Radiation therapy,
    • Axillary surgery type ( SLNB less than 10% incidence, ALND alone 19.3%, ALND and radiotherapy 30.1%.
    • Reconstruction doesn’t modify lymphoedema risk.
    • High BMI increased risk and fluctuations in weight greater than 10lbs increased the risk.
    • Subclinical lymphoedema may increase the risk of BCRL.
    • Cellulitis significantly increases the risk of BCRL.
  • Screening and early intervention may have financial benefits.
  • Precautionary guidelines need more rigorous and evidence based analysis.
  • Treatment analysis shows that there isn’t high level evidence nor consensus on when is the threshold to commence lymphoedema management. Increasing evidence for bandaging and all other forms of management strategies require further research.
  • There is growing evidence of the importance of exercise in this population. Larger randomised controlled trials are necessary to gain high-level evidence for alternative exercise interventions.