Axillary Treatment and Chronic Breast Cancer–Related Lymphedema: Implications for Prospective Surveillance and Intervention From a Randomized Controlled Trial

Abstract

Study finds that it is essential to screen for lymphedema. Early detection and intervention improves outcomes.

Breast Cancer-Related Lymphedema: Risk Stratification and a Continued Call for Screening

“…11 However, BCRL screening remains imperative for those at risk. We could not agree more with Boyages et al 1 that, in this study, screening and early intervention using BIS or TM worked across 13 settings in the United States and Australia, with increased awareness and patient education contributing to low BCRL rates. It is concerning that patients who live rurally had higher BCRL rates, independent of BMI, for all subgroups in this study.…”

“…It should be emphasized that, although risk is low, Naoum et al 4 found that the 5-year BCRL cumulative incidence rate was 8.0% for this group (SNB without RNI). BCRL may develop after 3 years postoperatively, and in the study by Boyages et al 1 , cBCRL actuarial risk was increasing from years 2 to 3 in this group. The authors suggest reducing screening frequency after 3 years for all groups.…”

“…Several methods of screening should be considered, and TM will always need a place in BCRL screening given its cost-effective nature. We applaud the conclusion by Boyages et al 1 that developing a screening program using the constraints of space and resources is vitally more important than comparing previously validated measuring techniques. National and international lymphatic organizations and academic medical institutions must work together to support access to BCRL screening for all patients diagnosed with BC and who are at risk of BCRL, a disease that imparts decreased health-related quality of life.…”

“…In their study Boyages et al 1 sought to identify risk factors for chronic breast cancer–related lymphedema (cBCRL) through secondary analysis of the previously published PREVENT trial. 2 This strong group of clinicians and researchers who have extensively published in BCRL, should be commended for undertaking this large, prospective, multisite, international study to explore BCRL screening techniques and progression to cBCRL in a large cohort of women diagnosed with breast cancer (N = 879).…”

“…As Boyages et al 1 pointed out, de-escalating treatment intensity in the axilla by avoiding ALND in patients with 1-2 positive sentinel nodes and using RNI instead will decrease BCRL risk, as per the AMAROS trial. 11 However, BCRL screening remains imperative for those at risk.…”