Lymphovenous Canada: Practical Tips for Preventing and Controlling Breast Cancer-Related Lymphedema

PREVENTION

Over 75% of breast cancer-related lymphedema occurs in the first three years after axillary dissection (with or without radiation). Arm infection/injury and weight gain are the only two statistically significant controllable risk factors for developing or aggravating lymphedema. Therefore, scrupulous skin care is recommended, at least for the first three years after breast cancer treatment.

This includes avoiding cuts, insect bites, pet scratches, burns (including sunburn), hang nails, contact irritants to the arm as well as medical procedures such as blood drawing, intravenous lines, vaccinations, blood pressure monitoring, and acupuncture. Liberal use of moisturizing creams, sunscreen, insecticides, oven mitts, protective gloves when gardening, and long sleeves should be encouraged.

When faced with breast cancer in both breasts, the arm that has not been subjected to axillary dissection or that of the least diseased breast (least number of cancerous nodes harvested from the axilla) should be used for medical procedures. The oldest arm, in terms of treatment, can also be used. For instance, if a woman, after having had breast cancer in the left breast, develops breast cancer in the right breast three years later, she could probably get away with using her left arm for procedures.

If the axilla on the breast cancer side has not been touched by radiation or dissection, it is probably very safe to use that arm for medical procedures. Drawing blood from or starting intravenous lines in the lower extremities can be very painful, inconvenient and prone to infection.

Maintenance of ideal body weight is important in preventing and controlling lymphedema. Exercise, such as running, cycling, swimming, hiking, walking may help in controlling weight. Vigorous upper body exercise such as rowing, tennis, squash, golf, skiing, racket ball has, so far, not been shown to worsen or cause lymphedema. Diet, unless used for weight loss, has not been shown to prevent or affect lymphedema.

CONTROLLING LYMPHEDEMA

For the control of lymphedema, compression therapy, especially the compression sleeve, has the best scientific support so far. Compression pumps, pneumatic pressure sleeves, and the bandaging techniques of MLD and CPT may be useful in reducing the lymphedema to a controllable size that can then be maintained by a compression sleeve.

Because there is anecdotal evidence that air travel may aggravate lymphedema, a compression sleeve for air travel may be advisable. Saunas, steam baths, a tropical climate can also aggravate lymphedema in some people.

As mentioned above, scrupulous skin care to prevent infection and ideal body weight maintenance are crucial for the control of lymphedema. If infection develops, which is almost always streptococcal, prompt treatment with an antibiotic such as a penicillin (first choice), cephalosporin or a macrolide is necessary. If recurrent infections occur, it may be advisable to have an emergency home supply of antibiotics to be taken at the earliest signs of infection. When traveling to a remote area, a supply of antibiotics should be taken along in case of infection.

If lymphedema develops or worsens abruptly, it is important to check for cancer in the axilla, infection or a blood clot in the arm.

For further information please refer to:

1. Canadian Medical Association Journal 2001;164(2):191-9 Clinical practice guidelines for the care and treatment of breast cancer. - Lymphedema

2. Cancer, September 15, 2001 / Volume 92 / Number 6. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis - Jeanne A. Petrek et al.