Early Screening Is Key to Treating Lymphedema in Breast Cancer Patients
Posted: July 16, 2008 at 1:00 am, Last Updated: November 30, -0001 at 12:00 am
Breast cancer patients in fear of developing lymphedema — a potentially painful and disfiguring condition of swelling in the extremities — may be in for some relief.
Naomi Lynn Gerber
Photo by Evan Cantwell
Lymphedema results from a disruption or blockage of the lymphatic system, which is responsible for transporting lymph fluid and cellular debris. Researchers at Mason, the National Naval Medical Center, the University of Michigan-Flint and the National Institutes of Health found that when physical therapists identified breast cancer-related lymphedema in its very early stages and had patients wear a light-grade compression bandage on the arm for four weeks, the condition was effectively treated.
During the five-year study, the team followed breast cancer patients at the National Naval Medical Center in Bethesda, Md., from initial diagnosis through treatment and rehabilitation. All participants were monitored one month after surgery and at three-month intervals thereafter for one year.
Using infrared technology to scan and measure the arms, early stage lymphedema was identified in 43 of the 196 study participants and a light-grade compression bandage was prescribed to those affected. The treatment reduced swelling and alleviated the condition in all of the affected women. Although compression garments are standard treatment, they are often used late in the course of the condition’s development.
“We were surprised by how easy it was to reverse the condition when it was identified in its beginning stages,” says Naomi Lynn Gerber, Mason professor and director of the Center for Study of Chronic Illness and Disability.
“For relatively minimal effort on the part of the health care provider and at relatively little cost and risk to the patient, we can easily find, treat and possibly reverse lymphedema.”
Gerber notes that the most challenging aspect of diagnosing lymphedema — which affects from seven to 47 percent of all breast cancer patients — is identifying the slight shift in fluid retention that eventually progresses to painful and disfiguring swelling of the upper arm.
“I think that lymphedema is an under-diagnosed problem because changes in fluid volume are subtle and are not usually picked up clinically until later stages when it is much more difficult to treat,” says Gerber.
Gerber explains that because of late diagnosis, the majority of breast cancer-related lymphedema cases are currently addressed using a costly, time-consuming and, at times, uncomfortable course of treatment. The treatment involves bulky prescription compression bandages, manual lymph drainage techniques, daily physical therapy sessions and sometimes prescription drugs. Many patients also suffer from infection as a side effect of lymph fluid blockage.
However, she hopes the study’s findings will lead to screening and careful monitoring of all breast cancer patients for the low levels of fluid accumulation that signify the onset of the condition.
“While more research is needed to confirm these findings, the take-home idea here is that detection depends on sensitive measures,” says Gerber. “If you identify lymphedema early, then it can be effectively treated with minimal intervention. That is very good news for breast cancer patients. It remains to be shown that this early intervention is sustained throughout the life of women with breast cancer.”
The study was cowritten by Nicole Stout Gergich, Lucinda Pfalzer, Charles McGarvey and Barbara Springer and published in the April 2008 issue of the journal Cancer.
The National Naval Medical Center and the National Institutes of Health funded the research.