ASCO Breast--lymphedema news--not so good

[Lani]

lymphedema is not sexy and has not gotten its fair share of research funds or interest it seems

Results rather depressing despite change to less invasive axillary surgery

And don't get excited--researcher is quoted saying they STILL see some cases after 5 years, so I guess the concern continues.


ASCO Breast: Lymphedema Risk Persists for Years

Breast cancer survivors have an ongoing risk of lymphedema for as long as five years after treatment ends, a study involving more than 200 patients showed.

Depending on the criteria used to define lymphedema, the five-year incidence ranged from 43% to 94%. Regardless of the definition employed, lymphedema incidence continued to increase during months 12 to 36 and months 36 to 60, as reported here at the American Society of Clinical Oncology's Breast Cancer Symposium.

The findings defy conventional wisdom that lymphedema persists only for the first 12 months after treatment, said Jane M. Armer, PhD, of the University of Missouri School of Nursing in Columbia. They also run counter to the belief that modern treatment techniques have substantially reduced the risk of lymphedema.

"We find that there still is an occurrence of lymphedema, after the latest treatment and based on the current protocols," Armer told MedPage Today. "More cases of lymphedema are seen between six and nine months after treatment, but even after 60 months we still see new cases, so there are late-occurring cases."

"Regardless of the criteria we used to define lymphedema, the incidence continued to increase during follow-up to 60 months."

As many as 40% of women with newly diagnosed breast cancer develop lymphedema after treatment. Initially, the swelling causes discomfort and possibly some disability. Subsequently, the condition can cause cellulitis and lymphangitis, predisposing patients to potentially life-threatening systemic infection.

Reports in the medical literature have widely varying estimates of lymphedema incidence, from 6% to more than 60%. Medical textbooks tend to have more moderate estimates in the range of 15% to 20%. The wide variation reflects the difficulty of attaining accurate measurement, diagnosis, and follow-up of patients, according to the poster presentation by Armer and colleagues.

In an effort to resolve some of the discrepancies, investigators prospectively followed 211 patients with newly diagnosed breast cancer for 60 months. They used three methods to assess lymphedema: perometry, circumference by tape measure, and self-reported signs and symptoms.

On the basis of the three assessment techniques, Armer and colleagues used four criteria to identify lymphedema:

A 2-cm change in circumference at any measured site
A 200-mL perometry limb volume change (LVC) in an affected arm
10% perometry LVC of the affected arm
Self-reported limb swelling or heaviness
Patients were assessed before and shortly after treatment and then at follow-up visits every three months for the first year and then every six months, until reaching a total follow-up of 60 months.

By the four different criteria used to define lymphedema, the 12-month incidence ranged from 22% to 66%. At 60 months, the range of lymphedema incidence was higher when categorized by all four definitions:

94% when defined by a 2-cm change in circumference
83% by 200-mL change in LVC
55% by 10% perometry LVC of the affected arm
43% by signs and symptoms
Ongoing analysis of the data includes a focus on identifying factors associated with late-occurring lymphedema, said Armer.

Armer and her co-investigators reported that they had no relevant disclosures.


Primary source: ASCO Breast Cancer Symposium
Source reference:
Armer J, et al "Lymphedema occurrence rates 1 to 5 years after breast cancer diagnosis" ASCO Breast 2010; Abstract 180.