Asdourian MS, Skolny MN, Brunelle C, Seward CE, Salama L, Taghian AG, et al.
The Lancet. Oncology. Date of publication 2016 Sep 1;volume 17(9):e392-405.
1. Lancet Oncol. 2016 Sep;17(9):e392-405. doi: 10.1016/S1470-2045(16)30204-2. Epub
2016 Aug 30.
Precautions for breast cancer-related lymphoedema: risk from air travel,
ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures,
and cellulitis.
Asdourian MS(1), Skolny MN(1), Brunelle C(2), Seward CE(1), Salama L(1), Taghian
AG(3).
Author information:
(1)Department of Radiation Oncology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA.
(2)Department of Physical and Occupational Therapy, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, USA.
(3)Department of Radiation Oncology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA. Electronic address: ataghian@partners.org.
Precautionary recommendations conveyed to survivors of cancer by health-care
practitioners to reduce the risk of breast cancer-related lymphoedema are
indispensable aspects of clinical care, yet remain unsubstantiated by high-level
scientific evidence. By reviewing the literature, we identified 31 original
research articles that examined whether lifestyle-associated risk factors (air
travel, ipsilateral arm blood pressure measurements, skin puncture, extreme
temperatures, and skin infections-eg, cellulitis) increase the risk of breast
cancer-related lymphoedema. Among the few studies that lend support to
precautionary guidelines, most provide low-level (levels 3-5) or inconclusive
evidence of an association between lymphoedema and these risk factors, and only
four level 2 studies show a significant association. Skin infections and previous
infection or inflammation on the ipsilateral arm were among the most clearly
defined and well established risk factors for lymphoedema. The paucity of
high-level evidence and the conflicting nature of the existing literature make it
difficult to establish definitive predictive factors for breast cancer-related
lymphoedema, which could be a considerable source of patient distress and
anxiety. Along with further research into these risk factors, continued
discussion regarding modification of the guidelines and adoption of a
risk-adjusted approach is needed.
Copyright © 2016 Elsevier Ltd. All rights reserved.
DOI: 10.1016/S1470-2045(16)30204-2
PMID: 27599144 [Indexed for MEDLINE]
