Breast Surgeons Share Strategies to Prevent Lymphedema

Dallas—The rate of lymphedema after breast cancer treatment has been decreasing, but up to 40% of those patients at highest risk for lymphedema still develop the incurable and potentially debilitating disease. At the 2019 meeting of the American College of Breast Surgeons, Sheldon Feldman, MD, described techniques surgeons can use to reduce the risk for lymphedema and preserve patients’ quality of life.

“Many of the surgical, medical and radiation procedures we subject patients to leave them with chronic issues,” said Dr. Feldman, the chief of breast surgical oncology, the director of breast cancer services, and a professor of surgery at Montefiore Medical Center, Albert Einstein School of Medicine, in New York City.

“The vast majority of our patients are asymptomatic when they come to us; the onus is on us to make sure they stay asymptomatic.”

As the meeting’s keynote speaker, actress Kathy Bates, put it, “Because ‘you’re’ successful, ‘we’re’ surviving, and now we need your help, to educate not just each other but all cancer surgeons … to help build a robust bridge from the trauma of surgery to quality of life after cancer.” Ms. Bates, who developed lymphedema (LE) after undergoing a double mastectomy, is the spokeswoman for the Lymphedema Education & Research Network.

Scope of the Problem

Globally, 250 million people suffer from LE and other lymphatic diseases; in the United States, that figure is around 10 million. The risk for LE after breast cancer treatment varies depending on the extent of surgery and other treatments; it affects 5% to 8% of patients who undergo sentinel lymph node (SLN) biopsy, 15% to 25% of patients who undergo axillary lymph node dissection (ALND), and 24% to 40% of patients who undergo ALND plus radiation.

“In addition to the number of nodes removed and radiation, other risk factors are elevated body mass index, advanced age, limited range of motion and Taxol [paclitaxel],” Dr. Feldman said.

About 90% of patients who develop LE do so within the first year of treatment, and 95% within three years. There is no cure for LE; treatments focus on slowing progression and treating the disease’s symptoms, primarily swelling and pain.

Unfortunately, these treatments, such as manual lymphatic drainage and pneumatic compression, may not be covered by insurance. There is a bill before Congress that would require coverage of compression garments, but patients pay out of pocket.

Although LE itself is not life-threatening, it leaves patients susceptible to cellulitis, which can trigger potentially fatal sepsis.

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