Test, Trigger, Treat
Breast cancer occurs when a mutation allows breast cells to grow without order or control and form a tumor.
Tumors in the breast tend to grow slowly. By the time a lump is large enough to feel, it may have been growing for as long as 10 years. Some tumors are aggressive and grow much faster.
Breast cancer-related lymphedema (BCRL) represents a major source of morbidity among breast cancer survivors. Breast cancer is the second most common cancer among women in the United States (some kinds of skin cancer are the most common).
Each year in the United States, about 264,000 cases of breast cancer are diagnosed in women and about 2,400 in men. About 42,000 women and 500 men in the U.S. die each year from breast cancer.
What causes breast cancer-related lymphedema (BCRL)?
If breast cancer spreads, it tends to move into the underarm lymph nodes because these nodes drain lymph from the breast. That’s why breast cancer surgeons often remove at least two or three lymph nodes from under the arm — called a sentinel lymph node biopsy (SLNB).
When surgeons have to remove many or most of the underarm nodes, it’s called an axillary lymph node dissection (ALND). These surgeries can cut off or damage some of the nodes and vessels that make up the pathways that lymph moves through. Over time, lymph can build up and overwhelm the remaining pathways, resulting in lymphedema — sometimes months or even years after breast cancer treatment ends. Radiation treatments also can affect the lymphatic system. The risk of radiation-related lymphedema is highest in people who receive radiation directly to the underarm because it’s where most of the lymph nodes are located. 1
Because lymphedema can be misdiagnosed or overlooked in mild cases, it’s difficult to know exactly how many women are affected. Experts estimate that from 5% to 40% of women will experience some level of lymphedema after breast cancer surgery. Your risk may be higher than this 5-40% range if you:
- have a full axillary lymph node dissection (lymph nodes above, below, and underneath the pectoralis minor muscle — known as levels I–III — are removed)
- have radiation to the lymph node areas after lymph node surgery
- have extensive cancer in the lymph nodes
- have chemotherapy
- choose mastectomy rather than lumpectomy
- are obese
- smoke heavily
- have diabetes
- have had surgery in the armpit area before now
Having sentinel lymph node dissection instead of axillary lymph node dissection can lower the risk of lymphedema, but there is still some risk. Research shows that between 3.7% and 17% of women will experience lymphedema after sentinel lymph node dissection.2
Lymphedema is abnormal swelling that happens when too much lymph collects in any part of the body. Lymph is a thin, clear fluid that circulates through the lymphatic system to remove waste, bacteria and other substances from the body’s tissues. Edema is the buildup of excess fluid.
Is it possible to prevent BCRL?
A recent study3, the PREVENT study published in December of 2022 in Lymphatic Research and Biology demonstrates clear clinical evidence that the early use of the Bioimpedance screening surveillance and utilization of compression garments is an effective tool in lymphedema prevention.
Bioimpedance Spectroscopy (BIS) is a technique used for estimating body composition that utilizes a weak electric current which flows through the body and the voltage is measured in order to calculate impedance (resistance) of the body.
As for the compression garment used, the innovative mediven® harmony arm sleeve was used in the study. Specifically, a mediven harmony 20-30 mmHg arm sleeve and a 20-30 mmHg gauntlet or glove was prescribed for those in the study who TRIGGERED positive. Patients who immediately entered compression therapy treatment and were compliant with the protocol, significantly reduced their chances of late-stage lymphedema.
Use of the mediven harmony arm sleeves and gauntlets assisted in preventing the progression of subclinical lymphedema in the largest randomized controlled trial focused on lymphedema prevention.
Therefore, it’s clear that early detection and compression prevents! All patients who have had breast cancer intervention are at risk for lymphedema.
References:
1 & 2. Breastcancer.org.
3. Sheila H. Ridner, Mary S. Dietrich, John Boyages, Louise Koelmeyer, Elisabeth Elder, T. Michael Hughes, James French, Nicholas Ngui, Jeremy Hsu, Vandana G. Abramson, Andrew Moore, and Chirag Shah. A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention. Lymphatic Research and Biology.Dec 2022.618-628.http://doi.org/10.1089/lrb.2021.0084
