On April 19, 2011, the Avon Foundation for Women, in partnership with the Lymphatic Research Foundation and the National Lymphedema Network, assembled a group of leading scientists and clinicians expert in breast cancer-related lymphedema to discuss the advances being made in the early-detection and early-intervention of upper extremity lymphedema, how such advances are improving management of the impairment and the need for clinical standardization of care. Below are resulting materials.
Breast Cancer Related Lymphedema
Breast cancer-related lymphedema (BCRL) is a chronic, debilitating disorder that is frequently misdiagnosed, treated too late or not treated at all. Lymphedema (LE) is an abnormal accumulation of protein-rich fluid in the interstitium, which leads to limb swelling, chronic inflammation and reactive fibrosis of the affected tissues resulting from damage to lymphatic circulation following surgery, chemotherapy and/or radiation therapy.
Lymphedema is common among the 2.3 million U.S. survivors of breast cancer, affecting approximately between 19-33% of survivors following axillary lymph node dissection (ALND) and radiation therapy (RT) and between 3.5-22% of survivors following sentinel node (SLN) biopsy and RT.
Essentially anyone with a breast cancerdiagnosis that undergoes surgery, chemotherapy and/or RT is at relative risk for LE.
Appropriate surveillance for lymphedema onset is essential and medically necessary due to documented risk in breast cancer survivors following treatment and for regular intervals afterward. Regular perometry or bioimpedance spectroscopy screenings (L-Dex) pre-surgery and in the years after successful cancer treatment can improve quality of life and reduce fear and the development of irreversible lymphedema.
Strategies needed to implement or improve rehabilitation services for breast cancer survivors in individual cancer institutions include:
- Surveillance for BCRL in all at-risk patients by their oncology or surgical providers using a pre-emptive surveillance approach.
- The development of more effective systems to recognize rehabilitation needs, provide rehabilitation care and facilitate evidence-based outcomes of rehabilitation in the cancer population.
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