Breast-Cancer Related Lymphedema: A Review of Procedure-Specific Incidence Rates, Clinical Assessment Aids, Treatment Paradigms, and Risk Reduction

Abstract

With improved outcomes following treatment of breast cancer, chronic toxicities including breast cancer related lymphedema (BCRL), gain increased significance with limited evidence-based guidelines present. This review attempts to summarize data addressing these concerns and provides recommendations based on currently published data. Substantial differences exist in rates of BCRL reported in the literature ranging from less than 5% to 65% based on locoregional therapy. Based on recent data, early diagnosis of BCRL appears critical and requires careful attention to patient risk factors and the use of newer diagnostic tools. Initial treatment with decongestive lymphatic therapy/compressive stockings can provide significant improvement in patient symptoms and volume reduction of edematous extremities. At this time, consensus recommendations for disease classification, diagnostic testing and treatment are still lacking. Awareness of the frequency of this toxicity is now important as more accurate clinical aids have become accessible to diagnose the condition at an earlier stage allowing timely intervention providing the opportunity for treatment strategies to be more effective.

Early Diagnosis of Lymphedema after Breast Cancer Treatment: Bio-Impedance Spectroscopy

“…On average, one fourth of patients receiving treatment for breast cancer develop lymphedema with the highest frequency being in the first 18 months following treatment (1)(2)(3)(4)(5)(6). In addition to the burden caused by cancer diagnosis following breast cancer treatment, the physical limitation of the arm due to lymphedema and the resulting social limitation, labor loss of patients, body image-related worry, anxiety depression and adaptation problems, social and sexual problems put the patients in a difficult condition in their professional and private lives.…”

“…It is difficult to identify the actual incidence of BCRL due to differences in the diagnostic and measurement methods and follow-up periods (1,2,4). The lack of a standard in measurement standards and differences of approach among centers are some of the difficulties experienced in approaching lymphedema.…”

“…The most frequent reason for secondary lymphedema in the upper and lower extremities is cancer-related lymphedema (1).…”

Bowenwork for symptom management of women breast cancer survivors with lymphedema: A pilot study

“…Armer, 2010; J. M. Armer & Stewart, 2010;Huang et al, 2013;Shah, Arthur, Riutta, Whitworth, & Vicini, 2012). All women who are diagnosed and treated for breast cancer are at risk of lymphedema; an average of 40% of survivors will be diagnosed with lymphedema (J. M. Armer & Stewart, 2010).…”

“…Ridner et al, 2013;Shah et al, 2012). With the emergence of nontraditional therapies, treating the adverse effects of lymphedema is gaining recognition in the United States (Acebedo, 2015;Fisher et al, 2014; S.H.…”