Pat Whitworth1, Frank Vicini2, Stephanie A Valente3, Kirstyn Brownson4, Beth DuPree5, Manpreet Kohli6, Laura Lawson1, Chirag Shah7. 1. Nashville Breast Center, Nashville, TN, USA. 2. Michigan Healthcare Professionals, Farmington Hills, MI, USA. 3. Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Department of General Surgery, University of Utah, Salt Lake City, UT, USA. 5. , Sedona, AZ, USA. 6. Department of General Surgery, RWJ Barnabas Health, West Long Beach, NJ, USA. 7. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. shahc4@ccf.org.
Abstract
PURPOSE: Breast cancer-related lymphedema (BCRL) represents a dreaded complication of breast cancer treatment that can lead to morbidity, diminished quality of life, and psychosocial harm and is associated with increased costs of care. Increasingly, data has supported the concept of prospective BCRL surveillance coupled with early intervention to mitigate these effects. METHODS: We performed a systematic review of the literature searching for published randomized and prospective data evaluating prospective BCRL surveillance with early intervention. RESULTS: We identified 12 studies (2907 patients) including 4 randomized trials (1203 patients) and 8 prospective studies (1704 patients). Randomized data consistently demonstrate that early intervention reduces rates of progression to chronic BCRL with multiple paradigms and diagnostic modalities utilized; the strongest data comes from the randomized PREVENT trial, which demonstrated early detection with bioimpedance spectroscopy (BIS), coupled with early intervention with a compression garment applied for 12 h a day over 4 weeks, significantly reduced the rate of chronic BCRL compared to tape measurement coupled with early intervention. CONCLUSIONS: Current data support the role of prospective BCRL surveillance with early detection and intervention to reduce rates of chronic BCRL. Breast cancer patients at risk for BCRL should undergo prospective surveillance as part of survivorship. Because level 1 data demonstrate that BIS is superior to conventional tape measure, it should be included as the standard BCRL diagnostic modality unless an equally effective modality is employed. IMPLICATIONS FOR CANCER SURVIVORS: Breast cancer survivor should undergo prospective BCRL screening with BIS.
PURPOSE: Breast cancer-related lymphedema (BCRL) represents a dreaded complication of breast cancer treatment that can lead to morbidity, diminished quality of life, and psychosocial harm and is associated with increased costs of care. Increasingly, data has supported the concept of prospective BCRL surveillance coupled with early intervention to mitigate these effects. METHODS: We performed a systematic review of the literature searching for published randomized and prospective data evaluating prospective BCRL surveillance with early intervention. RESULTS: We identified 12 studies (2907 patients) including 4 randomized trials (1203 patients) and 8 prospective studies (1704 patients). Randomized data consistently demonstrate that early intervention reduces rates of progression to chronic BCRL with multiple paradigms and diagnostic modalities utilized; the strongest data comes from the randomized PREVENT trial, which demonstrated early detection with bioimpedance spectroscopy (BIS), coupled with early intervention with a compression garment applied for 12 h a day over 4 weeks, significantly reduced the rate of chronic BCRL compared to tape measurement coupled with early intervention. CONCLUSIONS: Current data support the role of prospective BCRL surveillance with early detection and intervention to reduce rates of chronic BCRL. Breast cancer patients at risk for BCRL should undergo prospective surveillance as part of survivorship. Because level 1 data demonstrate that BIS is superior to conventional tape measure, it should be included as the standard BCRL diagnostic modality unless an equally effective modality is employed. IMPLICATIONS FOR CANCER SURVIVORS: Breast cancer survivor should undergo prospective BCRL screening with BIS.
Authors: F M Boccardo; F Ansaldi; C Bellini; S Accogli; G Taddei; G Murdaca; C C Campisi; G Villa; G Icardi; P Durando; F Puppo; C Campisi Journal: Lymphology Date: 2009-03 Impact factor: 1.286