University of Missouri - Columbia.
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Posted 03.21.06

Condition Affecting Breast Cancer Survivors Often Overlooked, MU Researcher Finds

COLUMBIA, Mo. -- It's a medical condition without a cure, but lymphedema is barely recognized as a serious health problem and often can go undiagnosed. This could change thanks to findings from a long-term study at the University of Missouri-Columbia's Sinclair School of Nursing.

Jane Armer.Lymphedema is caused by a compromised lymphatic system. This can occur after breast cancer surgery because of possible damage to the lymphatic drainage system. The condition causes serious swelling in the extremities due to lymph fluid accumulation. In addition to numerous physical effects, lymphedema also can result in psychological distress because normal, daily activities become difficult.

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The study, funded by the National Institutes of Health, followed more than 300 women diagnosed with breast cancer. After following these women two years post-surgery, results showed 40 percent of the women may have developed lymphedema. Lymphedema is reversible if caught early. It is manageable once it becomes chronic, but no longer reversible, said Jane Armer, professor of nursing.

The study examined four criteria for diagnosing lymphedema and used information that is not routinely collected in the clinical setting. The first method was to check for a two centimeter limb girth change when compared to pre-surgery measurements. The second method checked for a 200 centimeter volume change when compared to baseline information collected before surgery. The third component checked for a 10 percent lymph volume change, which Armer reported to be most accurate while also coinciding with symptoms women reported two years after surgery. The final method used patient reports of systems associated with lymphedema, such as a feeling of heaviness and/or swelling in the limb. Research suggested that both limb volume change and symptoms must be considered in lymphedema diagnoses.

"Many times women experience symptoms of lymphedema without realizing it. Often women notice a change in skin sensation, a feeling of heaviness in the extremity, tighter fitting rings or watches, or recurring swelling," Armer said. "It is these same women who do not have the two centimeter change in limb girth if the swelling takes place in the hand alone or if the amount of fluid decreases on the day of the doctor visit.

"These data are really giving us insight into this chronic condition," Armer said. "We have a lot of education to do for patients and health care professionals. At some point these women stop seeing an oncologist who might be more experienced in recognizing cancer treatment-related lymphedema. The women are followed by their regular physician who helps them manage their other health conditions and the patients may not realize something can be done for the lymphedema.

"Breast cancer survivors have a lifetime risk of developing lymphedema, a risk that does not diminish over time. In fact, according to one recent national study, 7 percent of women develop lymphedema within six months of surgery after having the least invasive breast cancer procedure," Armer said. "It is important to be vigilant about watching for signs and symptoms of lymphedema so we can reduce the risk for women everywhere and improve their quality of life."

The study's findings were the keynote presentation at the most recent annual meeting of the British Lymphology Society in Scotland. The findings also were published in Lymphatic Research and Biology, a journal of the Lymphatic Research Foundation.



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