Breast Cancer Related Lymphedema: A Review of Recent Developments

Abstract

With improved methods of detection and advancing treatment paradigms, breast cancer outcomes continue to improve. Along with this improved survivorship, an increased focus on long term sequelae of treatment must occur. Breast cancer related lymphedema (BCRL) represents one of the most frequently recognized complications following breast cancer treatment and has been found to be associated with the extent of locoregional therapy. With regards to incidence rates, several randomized trials have found that with utilization of less aggressive axillary staging (i.e., sentinel lymph node biopsies), that rates of BCRL are reduced compared with axillary lymph node dissections. Quantification of the rates of BCRL by treatment technique remains difficult as significant heterogeneity exists in incidence rates based on treatment delivered and diagnostic criteria employed. Diagnosis of BCRL remains a challenge as traditional modalities are limited by low sensitivity and inconsistent definitions; new diagnostic modalities including bioimpedance spectroscopy may allow for the detection of BCRL in the sub-clinical phase of the disease process with defined, reproducible criteria. Treatment modalities for BCRL utilized include compression devices, exercise, and complex decongestive physiotherapy (CDP) with recent data supporting the utilization of CDP over standard modalities; importantly, data has emerged supporting the utilization of treatment in the sub-clinical and early phases of treatment in order to minimize long term complications associated with BCRL.