Extensiveness of breast cancer surgery linked to risk of lymphedema

In In The News by Barbara Jacoby

LLH network pressFrom: Oncology Nurse Advisor

Breast cancer survivors who have extensive surgery are four times more likely to develop arm lymphedema. According to a new study, the extensiveness of surgery to treat breast cancer proportionately increases the risk of developing the debilitating disorder.

According to the lead author, Tracey DiSipio, PhD, from Queensland University of Technology in Brisbane, Australia, women who had undergone an axillary lymph node dissection, which is an invasive surgery to remove lymph nodes under the arm, were four times more likely to experience swollen or disfigured arms compared with women who had received a sentinel lymph node biopsy. The study was published in The Lancet Oncology (2013;14(6):500-515).

“Arm lymphedema is typically characterized by swelling in one or both arms, causing pain, heaviness, tightness, and a decreased range of motion,” DiSipio said. “The appearance of the swollen or disfigured arms provides an ever-present reminder of breast cancer and often contributes to anxiety, depression, and emotional distress in affected women.”

DiSipio said the study, a systematic review of the incidence of arm lymphedema after breast cancer, also found that the condition is diagnosed in one in five women (21.4%). She explained, “This is a significant research finding and provides us with the most accurate incidence rate to date. Until now the incidence rate has been reported as anywhere from 0% to 94%. With this information we can explore whether lymphedema rates differ between breast cancer survivors.”

The study also pinpointed a number of risk factors linked to arm lymphedema. Risk increased with a lack of regular physical activity and with a high body mass index. DiSipio said, “These factors are potential targets for future prevention strategies or for more effective management of the disorder.”

DiSipio said the results of the study added weight to calls to integrate prospective surveillance of arm lymphedema into standard breast cancer care.

“Currently there are no standardized practices when it comes to detection and treatment of arm lymphedema,” she said. “Given most patients present with the arm lymphedema within the first 2 years after breast cancer, more frequent surveillance throughout this time is recommended.”