Expert Advice on Breast-Cancer-Related Lymphedema
Marc Hurlbert, PhD, is the executive director of the global breast cancer programs for the Avon Foundation for Women and the Avon Breast Cancer Crusade, which has raised $700 million globally for research and advancing access to breast cancer care, regardless of a person's ability to pay. Hurlbert shares recommendations from a report he coauthored with lymphedema experts on the latest clinical advances, which could benefit many of the 2.3 million breast cancer survivors in the United States.
Q: What is breast-cancer-related lymphedema?
A: Breast-cancer-related lymphedema is a chronic, debilitating disorder following surgery, chemotherapy, or radiation therapy that causes arm swelling and chronic inflammation. Lymphedema can have devastating consequences for breast cancer survivors, including infection, loss of strength, and limitation of movement, as well as body-image and self-esteem issues and anxiety. The swelling, which can happen after lymph node removal, is caused by lymph, the colorless liquid that normally circulates in the body.
Q: Who is at risk of getting breast-cancer-related lymphedema?
A: Anyone with a breast cancer diagnosis who undergoes surgery, chemotherapy, or radiation therapy is at risk. Approximately 19% to 33% of survivors who have auxiliary lymph node dissection (the removal of lymph nodes in the armpit region) and radiation, and between 4% and 22% of survivors who have sentinel lymph node biopsy and radiation, develop lymphedema. Lymphedema risk appears to increase with obesity and higher body mass index.
Q: Are there other types of lymphedema besides breast-cancer-related lymphedema?
A: Yes, lymphedema can develop as a result of surgery, radiation therapy, infection, or trauma. It is common in patients following treatment for cancers other than breast cancer, including melanoma, gynecological, head and neck, prostate, testicular, bladder, and colon cancers. Surgery for these cancers currently requires the removal of lymph nodes, and lymph node removal can put patients at risk of developing lymphedema.
Q: How many people are currently suffering from lymphedema?
A: Lymphedema is very prevalent. Experts estimate there are 10 million people in the United States who have lymphedema resulting from cancer therapy, recurrent infections, injury, or vascular surgery.
Q: When does breast-cancer-related lymphedema first develop?
A: Lymphedema commonly occurs quite early after the course of breast cancer treatment. Experts advise that women be monitored closely for up to five years following treatment and receive additional surveillance for 10 years or beyond.
Next Page: How is lymphedema detected?
[ pagebreak ] Q: How is lymphedema detected?
A: Traditionally, lymphedema has been diagnosed by a doctor measuring a patient's arm circumference with a tape measure or by a patient's own assessment of her arm. However, by the time lymphedema is visually detectable, it has already evolved into advanced stages of the disorder.
New tools—such as bioimpedance spectroscopy (BIS), which is a way to measure body composition—are now available and provide an accurate lymphedema assessment. Experts recommend that doctors measure a patient's arm volume with BIS prior to breast cancer treatment and follow up with measurements at regular intervals once the treatment is completed.
Q: How can I minimize my risk?
A: Breast cancer patients and survivors should try to prevent any physical trauma— such as cuts, burns, or wearing tight jewelry, as well as excessive sun exposure—to the fingers or hands.
Being overweight can also increase your risk. Recent studies have shown that weight lifting, exercise, and weight loss can help prevent lymphedema. Lymphedema patients who stretched, did aerobics, and lifted weights had fewer flare-ups, and at-risk patients reduced the chance of developing the condition by 70%.
Q: Can lymphedema be prevented?
A: No. Currently, doctors are not able to prevent lymphedema or definitively determine who will develop the disorder. However, research shows that early stage lymphedema (stage 0–1) can often be resolved with simple interventions, while later stage lymphedema (stage 2–3) is irreversible.
Q: What is the treatment if I'm diagnosed with lymphedema?
A: At the earliest stages of lymphedema your doctor will treat you with a compression sleeve or garment until the symptoms are resolved. Compression therapy can be used again if your symptoms recur. At advanced stages of lymphedema, complex decongestive therapy or possible drug therapies may be needed. Enlist the help of certified or well-trained and experienced lymphedema therapists.
Q: Where can I get more information on breast-cancer-related lymphedema?
A: Visit the Avon Foundation website.
Q: How can people get involved in the fight against breast cancer?
A: Participate in one of the nine annual Avon Walk for Breast Cancer events. Registration is open for the 2012 season. I'm pleased to offer a $10 registration discount for Health.com readers. When registering at www.avonwalk.org, just enter the code 'WALK2' at checkout. If you can't commit to participating in a walk but want to get involved, purchase pink products that give back 100% of net profits to the Avon Breast Cancer Crusade. Go to Avon.com to purchase pink nail polish, tote bags, tennis bracelets, socks, and more. Lastly, sign up for the Love/Avon Army of Women to help breast cancer researchers in their work to end this deadly disease. The Army recruits healthy women of every age and ethnicity, as well as breast cancer survivors and women at high risk for the disease, to partner with breast cancer researchers.