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Long-Term Study Finds Factors Associated with Lymphedema in Breast Cancer Patients (dateline October 24, 2001)

A study that followed breast cancer patients 20 years after treatment finds that two factors appear to be associated with the high prevalence of lymphedema (chronic arm swelling): arm infection/injury and weight gain. The women in the study who experienced either of these factors after breast cancer surgery that included the removal of some of the axillary (armpit) lymph nodes were more likely to develop lymphedema than the women who did not have arm infections or gain weight after treatment. The researchers believe that the study supports the need to remove fewer lymph nodes during breast cancer treatment to reduce the chances of lymphedema.

When breast cancer cells begin to escape from the primary tumor site in the breast, they often first travel to the lymph nodes under the upper arm. Therefore, it is common for surgeons to remove some or all of the axillary lymph nodes during breast cancer surgery (mastectomy or lumpectomy) to determine if the cancer has spread, and if so, to what extent. However, there is substantial evidence the removing many of the axillary lymph nodes increases the risk of lymphedema.

While researchers know that 15% to 20% of women who undergo axillary node dissection (removal of the axillary lymph nodes) develop lymphedema, there is little data to explain why these women develop the condition while the other 80% to 85% of women who have lymph node surgery do not. The study by Jeanne A. Petrek, MD and her colleagues from Memorial Sloan-Kettering Cancer Center in New York is the first long-term study to examine lymphedema in women who underwent axillary node dissection.

For the study, Dr. Petrek and her colleagues studied 263 women who had axillary node dissections between 1976 and 1978. Through patient questionnaires and interviews, the researchers determined that 49% of the women had some form of arm swelling or discomfort after surgery and 77% of these women experienced arm swelling within three years of surgery. Dr. Petrek and her team then attempted to determine common factors (such as occupation, physical activity level, sports, etc.) among the women who experienced arm swelling.

The results of the study revealed that 74% of the women who developed lymphedema had suffered an arm injury or infection that required medical care following breast cancer treatment. Furthermore, women who gained 10 or more pounds after they were diagnosed with breast cancer were 20% more likely to develop lymphedema that those who did not gain weight. The researchers did not find any correlation between sports or occupations and lymphedema.

While further studies are needed to better understand what contributes to lymphedema, this research begins to pinpoint factors that increase the risk of arm swelling after axillary node dissection. According to Dr. Petrek and her colleagues, the study warrants breast cancer treatments in which fewer axillary lymph nodes are removed.

Sentinel lymph node biopsy is a relatively new procedure in which only one to three of the lymph nodes are removed to determine whether breast cancer has begun to spread. Current research on this technique indicates that sentinel lymph node biopsy may be associated with less pain and fewer cases of lymphedema than standard axillary dissection. However, because the procedure is new, long term data are not yet available. In fact, Dr. Petrek and her colleagues are currently evaluating patients who are undergoing sentinel lymph node biopsies.

Because lymphedema can become a chronic condition, breast cancer patients who have axillary lymph nodes removed as part of their treatment should be aware of the early signs of lymphedema to avoid long-term suffering.

Early signs of lymphedema include:

  • Feeling of tightness in the arm
  • Pain, aching or heaviness in the arm
  • Swelling and redness of the arm
  • Less movement/flexibility in the arm, hand, wrist
  • Rings, bracelets or sleeves do not fit

Patients should also discuss methods to help prevent lymphedema with their physicians prior to lymph node surgery. Other issues, such as arm exercises after breast cancer and lymph node surgery, should also be discussed.

Lymphedema alert bracelets are designed for breast cancer patients or survivors who have had lymph nodes removed as part of their treatment. The bracelets are worn on the wrist of the arm involved in surgery, denoting that surgery was performed on that side of the body. This alerts healthcare providers to perform blood work or other medical procedures on the other arm when possible. For a patient who has had bilateral lymph node removal, the bracelet can help make healthcare professionals aware of the patient’s surgical history and to proceed with caution when performing procedures on those limbs. See the resources section below for links to more information on lymphedema.

Additional Resources and References