Original Article

You have full text access to this OnlineOpen article

Preoperative assessment enables the early diagnosis and successful treatment of lymphedema†‡

  1. Nicole L. Stout Gergich PT, MPT, CLT-LANA1,§,*,
  2. Lucinda A. Pfalzer PT, MA, PhD2,
  3. Charles McGarvey PT, DPT, MS3,
  4. Barbara Springer PT, PhD, OCS, SCS4,
  5. Lynn H. Gerber MD5,
  6. Peter Soballe MD1

Article first published online: 21 APR 2008

DOI: 10.1002/cncr.23494

Issue

Cancer

Cancer

Volume 112, Issue 12, pages 2809–2819, 15 June 2008

Additional Information

How to Cite

Stout Gergich, N. L., Pfalzer, L. A., McGarvey, C., Springer, B., Gerber, L. H. and Soballe, P. (2008), Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer, 112: 2809–2819. doi: 10.1002/cncr.23494

Author Information

  1. 1

    Breast Cancer Department, National Naval Medical Center, Bethesda, Maryland

  2. 2

    Physical Therapy Department, University of Michigan-Flint, Flint, Michigan

  3. 3

    Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland

  4. 4

    Physical Therapy Department, Walter Reed Army Medical Center, Bethesda, Maryland

  5. 5

    College of Health and Human Services, George Mason University, Fairfax, Virginia

  1. §

    Fax: (301) 295-9076.

*CLT-LANA, National Naval Medical Center, 8901 Wisconsin Avenue, Building 10, Breast Care Center, fourth Floor West, Bethesda, MD 20889-5600

  1. †

    The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

  2. ‡

    This article is a US government work and, as such, is in the public domain in the United States of America.

Publication History

  1. Issue published online: 4 JUN 2008
  2. Article first published online: 21 APR 2008
  3. Manuscript Accepted: 11 FEB 2008
  4. Manuscript Revised: 30 JAN 2008
  5. Manuscript Received: 20 DEC 2007

Funded by

  • National Naval Medical Center
  • National Naval Medical Center [NNMC]. Grant Number: Protocol NNMC B01-052
  • National Institutes of Health (NIH)
  • Mark O. Hatfield Clinical Research Center
  • Rehabilitation Medicine Department, Physical Therapy Section. Grant Number: Protocol NIH 02-CC-0044)

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (413K)

Keywords:

  • breast cancer;
  • lymphedema;
  • early detection;
  • physical therapy;
  • early intervention;
  • compression;
  • optoelectronic volumetry;
  • subclinical lymphedema

There are no standard diagnostic criteria and no agreed upon treatment recommendations for early lymphedema. In this study, the authors demonstrated that a surveillance program was efficacious for detecting and treating early subclinical breast cancer-related lymphedema.

Abstract

BACKGROUND

The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE.

METHODS

LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase >3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P ≤ .001) comparing the LE cohort with an age-matched control group.

RESULTS

The time to onset of LE averaged 6.9 months postoperatively. The mean (±standard deviation) affected limb volume increase was 83 mL (±119 mL; 6.5% ± 9.9%) at LE onset (P = .005) compared with baseline. After the intervention, a statistically significant mean 48 mL (±103 mL; 4.1% ± 8.8%) volume decrease was realized (P < .0001). The mean duration of the intervention was 4.4 weeks (±2.9 weeks). Volume reduction was maintained at an average follow-up of 4.8 months (±4.1 months) after the intervention.

CONCLUSIONS

A short trial of compression garments effectively treated subclinical LE. Cancer 2008. Published 2008 by the American Cancer Society.

View Full Article (HTML) Get PDF (413K)