Abstract
Purpose
To examine the feasibility of a breast cancer-related lymphoedema (BCRL) screening programme. Additionally, to investigate the efficacy of bioimpedance analysis (BIA) compared to circumferential measurements (CM) in detecting BCRL.
Methods
This was a 12-month prospective feasibility study. Participants were recruited from two diagnostic breast clinics and consented to be screened for BCRL. Pre-surgical assessments were conducted, and participants were followed up at quarterly intervals. BIA and CM measurements were conducted at all time points. An L-Dex score of >10 or a 10-U increase from baseline or a ≥5 % increase in proximal, distal or total percentage volume difference (PVD) from baseline was indicative of BCRL. Information was collected on subjective symptoms, potential risk factors, demographics and medical data. Feasibility was based on uptake and retention.
Results
One hundred twenty-six participants were recruited with an attrition rate of 16.2 %. Participants’ mean age was 59 years with the majority having stage I (63.9 %), infiltrating ductal carcinoma (87.4 %). 31.6 % were identified as having BCRL, 90.3 % detected by CM and 35.5 % by BIA (p = ≤0.0001). We found no significant correlation between BIA and CM. Participants identified as having BCRL had a higher BMI, a recent injury to their ‘at-risk’ arm and more lymph nodes excised (p = <0.05). These findings were not evident across all time points. A large percentage of participants had transient BCRL when assessed by a lymphoedema physiotherapist.
Conclusions
BCRL screening is acceptable and valued by breast cancer survivors. Work needs to continue to establish the most effective screening tool and the natural behaviour of BCRL within the first-year post-surgery.
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References
Ferlay J, Shin H, Bray F, Forma D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917
Office for National Statistics (2012) Cancer incidence and mortality in the United Kingdom, 2008–2010. Available at: http://www.ons.gov.uk/ons/dcp171778_289890.pdf [Accessed 17.01.2014]
McLaughlin SA, Van Zee KJ (2010) The prevalence of lymphoedema and changes in practice to reduce its occurrence in women with breast cancer. Eur J Clin Med Oncol 2:23–29
Miaskowski C, Dodd M, Paul SM, West C, Hamolsky D, Abrams G, Cooper BA, Elboim C, Neuhaus J, Schmidt BL, Smoot B, Aouizerat BE (2013) Lymphatic and angiogenic candidate genes predict the development of secondary lymphoedema following breast cancer surgery. PLoS One 8:e60164. doi:10.1371/journal.pone.0060164
Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR (2008) Lymphoedema and quality of life in breast cancer survivors: the Iowa Women’s health study. J Clin Oncol 26:5689–5696
Paskett ED, Dean JA, Oliveri JM, Harrop JP (2012) Cancer-related lymphoedema risk factors, diagnosis, treatment and impact. J Clin Oncol 30:3726–3733
Clark B, Sitzia J, Harlow W (2005) Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM 98:343–348
Hayes SC, Janda M, Cornish B, Battistutta D, Newman B (2008) Lymphoedema following breast cancer: incidence, risk factors and effect on upper body function. J Clin Oncol 26:3536–3542
Penha TRL, Slangen JJG, Heuts EM, Voogd AC, Von Meyenfeldt MF (2011) Prevalence of lymphoedema more than five years after breast cancer treatment. Eur J Surg Oncol 37:1059–1063
DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14:500–515
National Lymphedema Network (2013) Position paper: screening and measurement for early detection of breast cancer related lymphedema. Available at: http://www.lymphnet.org/resources/position-paper-screening-and-measurement-for-early-detection-of-breast-cancer-related
Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW (2012) Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phy Ther 92:152–163
Ancukiewicz M, Miller CL, Skolny MN, O’Toole J, Warren LE, Jammallo LS, Specht MC, Taghian (2012) Comparison of relative versus absolute arm size changes as criteria for quantifying breast cancer-related lymphoedema. Breast Cancer Res Treat 135:145–152
Taylor R, Jayasinghe UW, Koelmeyer L, Ung O, Boyages (2006) Reliability and validity of arm volume measurements for assessment of lymphoedema. Phy Ther 86:205–214
Ridner SH, Dietrich MS, Deng J, Bonner CM, Kidd N (2009) Bioelectrical Impedance for detecting upper limb lymphoedema in non-laboratory settings. Lymphat Res Biol. doi:10.1089/lrb.2008.1003
Lucci A, Mackie McCall L, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection (ALND) compared with SLND alone in the American college of surgeons oncology group trial Z0011. J Clin Oncol 25:3657–3663
Schrenk P, Rieger R, Shamiyeh A, Wayand W (2000) Morbidity following sentinel node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer 88:608–614
Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, Hess T, Oertli D, Bronz L, Schnarwyler B, Wight E, Uehlinger U, Infanger E, Burger D, Zuber M (2007) Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 245:452–461
McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ (2008) Prevalence of lymphoedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26:5213–5219
Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Moneypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599–609
Cornish B (2006) Bioimpedance analysis: scientific background. Lymphat Res Biol 4:47–50
Moseley A, Piller N (2008) Reliability of bioimpedance spectroscopy and tonometry after breast conserving treatment. Lymphat Res Biol 6:85–87
Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath SL (2010) Assessment of breast cancer-related arm lymphoedema-comparison of physical measurement methods and self-report. Cancer Invest 28:54–62
Cornish BH, Chapman M, Hirst C, Mirolo B, Bunce IH, Ward LC, Thomas BJ (2001) Early diagnosis of lymphedema using multiple frequency bioimpedance. Lymphology 34:2–11
Ward LC (2006) Bioelectrical impedance analysis: proven utility in lymphoedema risk assessment and therapeutic monitoring. Lymph Res Biol 4:51–56
Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM (2002) Physiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema. Breast Cancer Res Treat 75:51–64
Specht MC, Miller CL, Russell TA, Horick N, Skolny MN, O’Toole JA, Jammallo LS, Niemierko A, Sadek BT, Shenouda MN, Finkelstein DM, Smith BL, Taghian AG (2013) Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression? Breast Cancer Res Treat 140:485–494
Stout NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 112:2809–2819
National Lymphedema Network (2011) Position Statement of the National Lymphedema Network. Screening and measurement for early detection of breast cancer-related lymphedema. Availabel at: http://www.massgeneral.org/cancer/assets/pdfs/ScreeningandMeasurement%20.pdf
Australasian Lymphology Association (2012) Monitoring for the early detection of breast cancer related lymphoedema. Available at: http://www.lymphoedema.org.au/ALA/Lymphoedema/Position_Statements/ALA/Lymphodema/Position_Statements.aspx?hkey=c2afe208-5f01-49c0-8fc9-21f7fff87d5b
Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Cancer SRA (2012) A prospective surveillance model for rehabilitation for women with breast cancer. Cancer 118:2191–2200
Kilbreath SL, Refshauge KM, Ward LC, Kastanias K, Yee J, Koelmeyer LA, Beith JM, French JR, Ung OA, Black D (2013) Factors affecting the preoperative and postoperative extracellular fluid in the arm on the side of breast cancer: a cohort study. Lymph Res Biol 11:66–71
Smoot B, Paul SM, Aouizerat BE, Elboim C, Levine JD, Abrams G, Hamolsky D, Neuhaus J, Schmidt B, West C, Topp K, Miaskowski C (2014) Side of cancer does not influence limb volumes in women prior to breast cancer surgery. Lymph Res Biol 12:189–193
Francis WP, Abghari P, Du W, Rymal C, Suna M, Kosir MA (2006) Improving surgical outcomes: standardising the reporting of incidence and severity of acute lymphoedema after sentinel lymph node biopsy and axillary lymph node dissection. Am J Surg 192:636–639
Stout NL, Pfalzer LA, Levy E, McGarvey C, Springer B, Gerber LH, Soballe P (2011) Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer. PM&R 3:1098–1105
Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS (2009) Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Lymph Res Biol 7:29–45
Hayes S, Cornish B, Newman B (2005) Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6 month follow-up. Breast Cancer Res Treat 89:221–226
Fu MR, Cleland CM, Guth AA, Kayal M, Haber J, Cartwright F, Kleinman R, Kang Y, Scagliola J, Axelrod D (2013) L-Dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity. Lymphology 46:85–96
Wu Z, Zhao J (2013) The problem with peripherally inserted catheters in China. Pak J Med Sci 29:896
Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zambe GKD, Scott-Conner C (2009) The risk of developing arm lymphoedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 16:1959–1972
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH (2010) Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg 145:1055–1063
Ugur S, Arici C, Yaprak M, Mesci A, Arici GA, Dolay K, Ozmen V (2013) Risk factors of breast cancer-related lymphedema. Lymphat Res Biol 11:72–75
Morcos B, Ahmad FA, Anabtawi I, Sba’ AM, Shabani H, Yaseen R (2014) Development of breast cancer-related lymphedema: is it dependent on the patient, the tumor or the treating physicians? Surg Today 44:100–106
Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, Miller LT, Demichele A, Solin LJ (2009) Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 27:390–397
Fu MR, Ridner SH, Hu SH, Stewart BR, Cormier JN, Armer JM (2013) Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psychooncology 22:1466–1484
Acknowledgments
This work was funded by Friends of the Cancer Centre, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast.
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The authors declare that they have no conflict of interest and confirm that they have control of all primary data and agree to allow the journal to review the data if requested.
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Blaney, J.M., McCollum, G., Lorimer, J. et al. Prospective surveillance of breast cancer-related lymphoedema in the first-year post-surgery: feasibility and comparison of screening measures. Support Care Cancer 23, 1549–1559 (2015). https://doi.org/10.1007/s00520-014-2504-9
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DOI: https://doi.org/10.1007/s00520-014-2504-9