Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments

Abstract

Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer treatment, and well-established risk factors include axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR). BCRL affects approximately 1 in 5 patients treated for breast cancer, and it has a significant negative impact on patients' quality of life after breast cancer treatment, serving as a reminder of previous illness. This paper is a comprehensive review of the current evidence regarding BCRL risk factors, precautionary guidelines, prospective screening, early intervention, and surgical and non-surgical treatment techniques. Through establishing evidence-based BCRL risk factors, researchers and clinicians are better able to prevent, anticipate, and provide early intervention for BCRL. Clinicians can identify patients at high risk and utilize prospective screening programs, which incorporate objective measurements, patient reported outcome measures (PROM), and clinical examination, thereby creating opportunities for early intervention and, accordingly, improving BCRL prognosis. Innovative surgical techniques that minimize and/or prophylactically correct lymphatic disruption, such as axillary reverse mapping (ARM) and lymphatic-venous anastomoses (LVAs), are promising avenues for reducing BCRL incidence. Nonetheless, for those patients with BCRL who remain unresponsive to conservative methods like complete decongestive therapy (CDT), surgical treatment options aiming to reduce limb volume or restore lymphatic flow may prove to be palliative or corrective. It is only through a strong team-based approach that such a continuum of care can exist, and a multidisciplinary approach to BCRL screening, intervention, and research is therefore strongly encouraged.

Lymphedema after treatment of breast cancer: a comprehensive review

“…A well-studied, independent risk factor for BCRL is high BMI, defined as BMI > 30 kg/m 2 [35,50,56-60] . Jamallo et al [62] and other smaller studies have also correlated this finding that women with BMI of 30 kg/m 2 or greater, were at least 3.6 times more likely to develop BCRL [53,61] . Furthermore, Jamallo et al [62] found that post-operative weight fluctuations greater than 10 pounds per month, either lost or gained, increased BCRL [53] .…”

“…Jamallo et al [62] and other smaller studies have also correlated this finding that women with BMI of 30 kg/m 2 or greater, were at least 3.6 times more likely to develop BCRL [53,61] . Furthermore, Jamallo et al [62] found that post-operative weight fluctuations greater than 10 pounds per month, either lost or gained, increased BCRL [53] . With this information, counseling patients about healthy weight, as well managing weight fluctuations, can contribute to helping to decrease the incidence of BCRL with this well-known, modifiable risk factor.…”

“…In addition to the known risk factors for BCRL, there are conflicting studies about adjuvant and neoadjuvant chemotherapy as possible risk factors for BCRL. Some studies indicate that adjuvant chemotherapy is a potential risk factor for BCRL [4,[48][49][50][51][52][53] . DiSipio et al [4] did a meta-analysis of 72 studies published from 2000 to 2012 to assess the incidence rates of BCRL, and a meta-analysis of 29 studies published from 2000 to 2012, to assess the risk factors.…”

Comparison of real-time ultrasound imaging for manual lymphatic drainage on breast cancer-related lymphedema in individuals with breast cancer: a preliminary study

“…MLD performed by a therapist was more effective than self-massage in reducing edema [16], and more effective when CDT was applied with MLD [21]. MLD is more effective when applied with other compression methods, such as garment and bandaging, pneumatic compression, and limb exercise, in order to decrease lymphedema [15,22]. MLD was studied because of its effects in decreasing lymphedema.…”

Complicaciones postoperatorias en mujeres con cirugía por cáncer de mama

“…Otros factores están relacionados con las características de la mujer como la obesidad, el tabaquismo, entre otros. Algunas de las recomendaciones para reducir el riesgo de linfedema están centradas en un manejo interdisciplinario de manera preventiva y correctiva; como es el uso de método ganglio centinela para reducir en gran medida el número de ganglios a extirpar, así como el uso de manga de compresión y rehabilitación temprana del brazo afectado [24][25][26] .…”