In a letter published in Cancer, Schonholz1 acknowledged the work by Stout Gergich et al2 that suggested that the early detection of lymphedema leads to successful treatment. Schonholz1 reported the 2 limitations of the work to be the lack of a control group and the lymphedema assessment method used. It is generally accepted that the lack of treatment for lymphedema leads to disease progression. Although, to the best of our knowledge, the scientific evidence to support this theory remains scarce, withholding treatment means that the development and implementation of a true randomized controlled trial with which to assess lymphedema strategies is unlikely. Nonetheless, randomized controlled trials comparing the effectiveness of various treatment strategies are plausible. The work of Stout Gergich et al2 provides the necessary preliminary information to support compression as a treatment strategy worthy of further investigation.

As highlighted by the correspondence between Schonholz and Stout Gergich,1 lymphedema can be assessed using several self–report and objective methods, and there is controversy regarding which method(s) represent the “gold standard.” This is a major issue in lymphedema research because the manner by which lymphedema is measured significantly influences the results and conclusions derived from research relating to its incidence and potential risk factors as well as the effectiveness of prevention and/or treatment strategies.3 The work from our group has demonstrated this in several publications that have involved prospectively designed studies that make use of objective (including bioimpedance spectroscopy, circumference measurements, and perometry) as well as self–report measures.3-6 When deciding which method(s) are optimal, research and clinically relevant factors must be considered. Is it accurate, sensitive, and specific? Can it detect “subclinical” lymphedema (before patients report symptoms)? Is it affordable? Is it transportable? Is intertester error low? Is the measurement fast and noninvasive? Bioimpedance spectroscopy is a technology that demonstrates all these features and therefore will remain our primary measurement tool in the investigation of lymphedema after breast cancer.


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  • 1
    Schonholz SM. Preoperative assessment enables the early detection and successful treatment of lymphedema [letter]. Cancer. 2009; 115: 909; author reply 909-910.
  • 2
    Stout Gergich NL, Pfalzer LA, McGarvey C, et al. Preoperative assessment enables the early detection and successful treatment of lymphedema. Cancer. 2008; 112: 2809-2819.
  • 3
    Hayes SC, Janda M, Cornish B, et al. Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors. Lymphology. 2008; 41: 18-28.
  • 4
    Hayes SC, Janda M, Cornish B, et al. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008; 26: 3536-3545.
  • 5
    Cornish BH, Chapman M, Hirst C, et al. Early diagnosis of lymphedema using multiple frequency bioimpedance. Lymphology. 2001; 34: 2-11.
  • 6
    Cornish BH, Bunce IH, Ward LC, Jones LC, Thomas BJ. Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes. Breast Cancer Res Treat. 1996; 38: 169-176.

Sandi Hayes MD*, Bruce Cornish MD*, Beth Newman MD*, * Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.