Despite the low risk of lymphedema after sentinel lymph node biopsy (SLNB), most women worry about this complication and practice risk-reducing behaviors to avoid it, researchers have found.
Lymphedema will typically occur within 3 years of breast cancer treatment, if it occurs at all, according to information from the American College of Surgeons (ACS).
Approximately 20% of women who have had axillary lymph node dissection (ALND) will be affected, compared with about 5% of those undergoing SLNB. ALND is a more extensive procedure, involving the removal of an average of 10 to 20 lymph nodes from the armpit to assess for the presence of cancer. In SLNB, only a few lymph nodes closest to the breast are removed for analysis.
Women are often advised to take such preventive measures as avoiding needle punctures, blood draws, or blood pressure readings in the affected arm and using compression garments.
However, “Clinicians don’t really know what causes lymphedema, and there is an overall lack of data supporting or refuting these risk-reducing practices,” acknowledged Sarah McLaughlin, MD, in the ACS statement.
To evaluate the trends in lymphedema development, patient worry, and risk-reduction behaviors, McLaughlin, an assistant professor of surgery at the Mayo Clinic in Jacksonville, Florida, led a prospective study of 120 women, age 52 to 68 years, who underwent SLNB (67 patients) or ALND (53 patients) as part of their breast cancer treatment.
The investigators assessed for lymphedema by upper-extremity volume preoperatively and at 6 months and 12 months postoperatively, defining lymphedema as a volume change of more than 10% from baseline relative to the contralateral upper extremity. During their postoperative visits, study participants completed questionnaires regarding their lymphedema risk-reduction behaviors and were assessed for their fear and worry toward developing the condition.
McLaughlin’s team reported the following main findings in Journal of the American College of Surgeons (2013;216:380-389):
- Overall, 75% of the ALND patients and 50% of the SLNB patients had persistent worry about lymphedema at follow-up.
- At 12 months, only 19% of the ALND patients and 3% of the SLNB patients had actually developed lymphedema. (Lymphedema occurrence was similar between the two groups at the 6-month mark.)
- At 12 months, the extent of axillary surgery was the only significant risk factor for developing lymphedema.
- Among the women with volume change of 0% to 9% at 6 months, 22% had progressive swelling, and 18% resolved their volume changes at 12 months.
- No differences existed in the number of risk-reducing behaviors practiced by the two groups. The majority adopted as many as five precautionary behaviors as early as 6 months after their surgery and maintained these behaviors long term.
Future research should focus on better predicting which women will develop lymphedema, thus allowing for targeted prevention and intervention strategies as well as individualized plans for risk-reducing behaviors, contended McLaughlin and colleagues. ONA