Lymphedema risk persists long after breast cancer treatment, long-term monitoring required
Click Here to Manage Email Alerts
Women with breast cancer are at risk for lymphedema long after their treatment concludes, according to study findings.
Vigilant monitoring should continue for at least 3 years, researchers concluded.
“This isn’t something we can forget about when they have a 1-year follow-up and everything looks good,” study lead author Chirag Shah, MD, co-director of the breast cancer program, director of strategic growth and director of breast radiation oncology at Cleveland Clinic, told Healio. “It’s something we have to continue to watch for as part of survivorship and breast cancer care in the long term.”
More than 80% of people with breast cancer may be at risk for lymphedema based on the type of treatment they undergo, according to American Cancer Society.
Aggressive local therapies like axillary lymph node dissection or axillary radiation can elevate a person’s risk, Shah said.
The resulting swelling caused by a buildup of lymph fluid can be debilitating and considerably affect cancer survivors’ quality of life.
In the randomized controlled PREVENT trial, researchers compared two approaches — bioimpedance spectroscopy or tape measurement — for detection of subclinical breast cancer-related lymphedema (BCRL), followed by subsequent intervention in hopes of preventing its progression.
Results showed a 92% reduction in risk for progression to chronic BCRL, with reduced progression risk among women followed with bioimpedance spectroscopy.
In a secondary analysis of the PREVENT trial, Shah and colleagues examined the timing of subclinical and chronic BCRL.
The analysis included 919 women at risk for chronic BCRL who underwent regular screening with bioimpedance spectroscopy or tape measurement for up to 3 years after breast cancer treatment. Those diagnosed with subclinical BCRL underwent a 4-week compression sleeve intervention.
Researchers identified 209 women with subclinical BCRL, 30 of whom progressed after the intervention.
More than half of women who developed subclinical BCRL had measurements consistent with the condition within 9 months of treatment completion. However, others had initial detection much later, with researchers reporting consistent detection rates in year 2 and year 3 after surgery.
“We should be asking patients if they are having any clinical symptoms of lymphedema so we can intervene,” Shah said. “We don’t want to rely just on measurements. We want to use measurements and our own clinical judgment in discussion with patients.”
Thirty-nine women progressed to chronic BCRL without developing subclinical BCRL.
Shah said he often is asked about optimal approaches for lymphedema screening.
“We would love to follow patients for [many] years, [screening] every few weeks or every few months. However, that’s not realistic,” Shah said. “The data tell us we should follow them the most closely during the first year. Guidelines typically recommend every 3 months for the first year, and then we can potentially slowly back away from that as the years go on.”
For more information:
Chirag Shah, MD, can be reached at shahc4@ccf.org.
Collapse
Click Here to Manage Email Alerts