Resources for the Providers


About Lymphedema and Breast Cancer

Lymphedema is a condition that can cause significant swelling of the arm and hand due to excess lymph fluid building up. This can occur when the lymphatic system, which is responsible for draining excess fluid, is damaged or altered by surgery and/or radiation therapy.

Women who have had surgery to remove lymph nodes and/or radiation therapy are at risk of developing lymphedema. If lymphedema is not diagnosed early or managed appropriately, it may become a long-term, irreversible condition affecting quality of life and appearance.

It is estimated that 6 percent to 40 percent of patients with breast cancer develop lymphedema, and that it often occurs within the first two years after surgery. For some cancer survivors and others at risk, a low level lymphedema can occur 10 years to 15 years following the initial primary treatment and develop into a condition that has a serious impact on overall health and quality of life.

Today, most lymphedema is not diagnosed until swelling is visually apparent. By this point, changes within the arm caused by stagnant, protein rich extra-cellular fluid have already begun. Emerging new solutions now demonstrate that early assessment, diagnosis and intervention may help prevent progression and protect a woman's quality of life.

 

Groundbreaking New Data Demonstrates that Early Diagnosis and Treatment are Effective in Controlling Lymphedema

In Spite of Advances, Lymphedema Remains a Significant Problem Even With the Adoption of More Conservative Breast Treatment.

Breast Cancer Chart
Early detection has always been a key goal in successfully treating cancer. Improved surgical techniques and targeted therapies have also extended 5 year survival rates. Yet even with such new techniques as sentinel lymph node biopsy, incidence rates of lymphedema in 4-17% are cited in the literature for breast cancer patients1-7.

Today, most lymphedema is not diagnosed until it is visually apparent. By this point, fibrotic changes and lipid deposition caused by protein rich extra-cellular fluid stasis have already begun. Following the medical model, emerging new solutions now demonstrate that early assessment, diagnosis and intervention prevents progression and helps protect your patient’s quality of life.

 

Early Detection and Treatment are Key

Scientists don't yet fully understand why some women develop lymphedema while others don't. It is known that earlier detection of lymphedema allows earlier treatment and a better chance of a return to normal function, activities and appearance.

A new FDA-cleared, technology called bioimpedance spectroscopy (BIS) allows a medical provider to clinically assess and treat the onset of lymphedema earlier. BIS can detect increased fluid levels before visible swelling. Having a baseline test performed before breast cancer treatment begins allows the medical team to better understand what is 'normal' in that patient. It is then easier to detect any lymphedema very early in its development. Earlier treatment of lymphedema often means a better quality of life.

New data from a five year study conducted by the National Institutes of Health (NIH) demonstrate that it is possible to prevent the progression of lymphedema in patients at risk.8 Pre-surgical baselines establish what is 'normal' for the patient in terms of fluid levels in their arms. Periodic post-operative clinical assessment can detect significant changes from pre-surgical levels. An off-the-shelf compression garment has been demonstrated to be an effective intervention. In the NIH study, all women diagnosed with subclinical lymphedema, before visible swelling, returned to their pre-surgical baseline arm volume after approximately a month.

 

Letters of: Medical Necessity, Appeal, Patient Waiver

Published Papers and Clinical References

Authors Title Publisher Date Vol Page Number
Brian D. Lawenda, Tammy E. Mondry and Peter A. S. Johnstone Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment A Cancer Journal for Clinicians 2009 59 8-24
Hayes, S., Janda, M., Cornish, B., Battistutta, D. & Newman, B. Lymphedema Secondary to Breast Cancer: How choice of measure influences daignosis, prevalence, and idenitfiable risk factors. Lymphology 2008 41 18-28
Stout Gergich, N. L., Pfalzer, L. A., McGarvey, C., Springer, B., Gerber, L. H. & Siballe, P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 2008 112 2809-19
Rockson, S. G. Bioimpedance analysis in the assessment of lymphoedema diagnosis and management. Journal of Lymphoedema 2007 2 44-8
Warren, A. G., Brorson, H., Borud, L. J. & Slavin, S. A. Lymphedema: A Comprehensive Review. Annals of Plastic Surgery 2007 59 464-472
Warren, A. G., Janz, B. A., Slavin, S. A. & Borud, L. J. The use of bioimpedance analysis to evaluate lymphedema. Annals of Plastic Surgery 2007 58 541-3
Cornish, B. Bioimpedance analysis: scientific background. Lymphatic Research Biology 2006 4 47-50
Rockson, S. G. Addressing the unmet needs in lymphedema risk management. Lymphatic Research Biology 2006 4 42-6
Ward, L. C. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Lymphatic Research and Biology 2006 4 51-6
Cornish, B. H., Chapman, M., Hirst, C., Mirolo, B., Bunce, I. H., Ward, L. C. & Thomas, B. J. Early diagnosis of lymphedema using multiple frequency bioimpedance Lymphology 2001 34 2-11
Rockson, S. G. Lymphedema. American Journal of Medicine 2001 110 288-95

(1) Francis WP , Abghari P , Du W, Rymal C, Suna M, Kosir MA. Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection. Am J Surg 2006;192(5):636-9. Available from http://www.ncbi.
(2) Armer J, Fu MR, Wainstock JM, Zagar E, Jacobs LK. Lymphedema following breast cancer treatment, including sentinel lymph node biopsy. Lymphology 2004;37(2):73-91. Available from PM:15328760
(3) Leidenius M, Leivonen M, Vironen J, von Smitten K. The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J.Surg.Oncol. 2005;92(1):23-31. Available from PM:16180231
(4) Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. 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 2007;245(3):452- 61. Available from http://www.ncbi..nlm.nih.gov/entrez/query.fcgi?cmd= Retrieve&db=PubMed& dopt=Citation&list_uids=17435553
(5) Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM. 2005;98(5):343-48. Available from PM:15820971
(6) Umberto Veronesi, M.D., Giovanni Paganelli, M.D., Giuseppe Viale, F.R.C.Path., Alberto Luini, M.D., Stefano Zurrida, M.D., Viviana Galimberti, M.D., Mattia Intra, M.D., Paolo Veronesi, M.D., Chris Robertson, Ph.D., Patrick Maisonneuve, Eng., Giuseppe Renne, M.D., Concetta De Cicco, M.D., Francesca De Lucia, M.D. and Roberto Gennari, M.D.: A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer . N Engl J Med Volume 349;6:546-553 August 7, 2003
(7) Haid et al: Morbidity of Breast Cancer Patients Following Complete Axillary Dissection or Sentinel Node Biopsy Only: A Comparative Evaluation. Breast Cancer Research and Treatment Volume 73, Number 1 / May, 2002
(8) Gergich, et al. Cancer, Vol 112, No 2, June 2008, pp 2809-2819