Get the Facts About Lymphedema Prevention
March is Lymphedema Awareness Month. Those who have had conventional cancer treatment such as radiation therapy are always at risk for developing this sometimes debilitating condition. Breast cancer patients who have gone through radiation, chemotherapy, and especially lymph node removal surgery are at an even higher risk. Yet, breast cancer patients in particular often get mixed messages about their risk of developing lymphedema.
What is the real deal when it comes to lymphedema? And, most importantly, what can you do to make sure it doesn’t affect you?
Confusion About Lymphedema and Breast Cancer
A 2013 study came to the surprising conclusion that “the clear majority of women who undergo breast cancer operations worry about developing [lymphedema] and… this fear far exceeds their actual risk of getting [it].”
The study, which was conducted at the Mayo Clinic in Florida and published in the Journal of the American College of Surgeons, followed 120 women ages 52-68 for 12 months. 53 of the women had undergone Axillary Lymph Node Dissection (ALND), where lymph nodes are removed under the arm, and 67 had undergone Sentinel Lymph Node Biopsy (SLNB), where lymph nodes are removed from areas where the primary tumor is most likely to spread.
Even more shocking was their conclusion that “age, weight, type of breast operation (breast-conserving or mastectomy), or radiation were not linked to an increase in lymphedema.”
When I heard of this study, I was not only confused but also saddened and deeply concerned.
The fact is that lymphatic conditions affect millions of Americans each year and many of these individuals are recovering from cancer. Those who have received conventional treatment for prostate, uterine, neck or head cancer, as well as breast cancer patients who have had either ALND or SLNB, are especially at risk. According to the National Cancer Institute, between 5-17% of women who have SLNB will develop lymphedema. Of those who elect to have ALND surgery, the percentage is much higher − between 20-53%.
All experts agree that the number of lymph nodes removed is the greatest factor in determining lymphedema risk for breast cancer patients. For those who choose to have several or all their mammary-area lymph nodes removed, the lymphedema percentage shoots to 70%.
And in terms of other risk factors such as weight gain and radiation exposure, the Mayo Clinic study goes completely against what studies have concluded for years.
“Clinical studies have provided evidence that obesity and postoperative weight gain are significant risk factors for the development of lymphedema,” said a 2015 study conducted by Memorial Sloan-Kettering Cancer Center. And another 2015 study conducted by Massachusetts General Hospital found that women who had regional lymph node radiation (RLNR) had a significantly higher risk for getting the condition.
What Causes Lymphedema?
The Mayo Clinic report also stated that the most common at-home practices that women can do to prevent lymphedema from occurring, such as skin brushing and movement exercises, most likely have little or no effect. They go on to state that women (who, in their opinion, are worried mostly about disfiguration) “adopt practices that are basically grounded in myth, not fact.”
“Clinicians don’t really know what causes lymphedema, and there is an overall lack of data supporting or refuting these risk-reducing practices,” Sarah McLaughlin, MD, of the Florida Mayo Clinic and the lead author of the study, said in the final report.
First, what causes lymphedema, especially as it relates to cancer treatment, is clear. Besides the skin, the lymphatic system is the body’s most important line of defense for harmful pathogens such as bacteria, yeasts, viruses, and infection. Throughout the system, lymph nodes act as “filter stations” for these unwanted guests.
Lymph circulates throughout the system and transports the harmful substances to the nodes and then through detoxification pathways in the body. Lymphedema can occur after lymph node removal (or after lymph node damage occurs through radiation or chemo) because the lymph has nowhere to go or the nodes are weak and not working properly. Fluid can get trapped below the surface of the skin.
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