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Gland Surg. 2018 Aug;7(4):379-403. doi: 10.21037/gs.2017.11.04.

Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments.

Author information

1
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
2
Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.

Abstract

Breast cancer-related lymphedema (BCRL) is a negative sequela of breast cancer treatment, and well-established risk factors include axillary lymph node dissection (ALND) and regional lymph node radiation (RLNR). BCRL affects approximately 1 in 5 patients treated for breast cancer, and it has a significant negative impact on patients' quality of life after breast cancer treatment, serving as a reminder of previous illness. This paper is a comprehensive review of the current evidence regarding BCRL risk factors, precautionary guidelines, prospective screening, early intervention, and surgical and non-surgical treatment techniques. Through establishing evidence-based BCRL risk factors, researchers and clinicians are better able to prevent, anticipate, and provide early intervention for BCRL. Clinicians can identify patients at high risk and utilize prospective screening programs, which incorporate objective measurements, patient reported outcome measures (PROM), and clinical examination, thereby creating opportunities for early intervention and, accordingly, improving BCRL prognosis. Innovative surgical techniques that minimize and/or prophylactically correct lymphatic disruption, such as axillary reverse mapping (ARM) and lymphatic-venous anastomoses (LVAs), are promising avenues for reducing BCRL incidence. Nonetheless, for those patients with BCRL who remain unresponsive to conservative methods like complete decongestive therapy (CDT), surgical treatment options aiming to reduce limb volume or restore lymphatic flow may prove to be palliative or corrective. It is only through a strong team-based approach that such a continuum of care can exist, and a multidisciplinary approach to BCRL screening, intervention, and research is therefore strongly encouraged.

KEYWORDS:

Breast cancer-related lymphedema (BCRL); lymphedema; lymphedema precautionary measures; lymphedema risk factors; lymphedema treatment

Conflict of interest statement

Conflicts of Interest: AG Taghian has been loaned equipment from ImpediMed for use in an investigator initiated clinical trial. ImpediMed has had no involvement in the conception or reporting of our research activities. AG Taghian has been a consultant for VisionRT (image-guidance radiation oncology). The other authors have no conflicts of interest to declare.

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