title: Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer.
abstract: There has recently been considerable interest for the need for specialist lymphoedema nurses to be appointed in the NHS. However, we had noticed in our cancer follow-up clinics that the incidence of lymphoedema appeared to be very low. Treatment for primary breast cancer (>5 cm) has been surgery and low axillary sampling (ANS). Radiotherapy (RT) or axillary clearance is subsequently performed in patients found to be node positive. The patients are followed-up in the primary breast cancer (PBC) clinic weekly. Follow-up is initially at 3-month intervals up to 2 years and then 1 yearly indefinitely. We conducted a two phased study in patients being followed up in our post cancer clinic in order to identify the incidence of LE in these patients. Phase 1 involved symptomatic patients identified at routine follow up in a 15-week period and the number of patients reporting arm swelling was recorded. The aim of this was to provide an estimate to power a phase 2 study (prospective questionnaire based). Phase 2 was conducted over a 13-week period. All patients attending the clinic were administered modified FACT B4, EQ-50 and Speilberger questionnaires. A total of 1242 patients were examined and lymphoedema found in 5 (0.04%). Of these 5, 3 had undergone axillary clearance, 1 ANS plus radiotherapy and only 1 had ANS alone. A policy of ANS, with prophylactic treatment for lymph node positivity either by surgery or RT alone, gives a very low rate of lymphoedema.
authors.affiliation: Breast Cancer Unit, Nottingham City Hospital, Nottingham NG1 5PB, UK. mszrsr@msn1.surgery.nottingham.ac.uk
authors.forename: R S
authors.initials: RS
authors.lastname: Rampaul
authors.forename: K
authors.initials: K
authors.lastname: Mullinger
authors.forename: R D
authors.initials: RD
authors.lastname: Macmillan
authors.forename: J
authors.initials: J
authors.lastname: Cid
authors.forename: S
authors.initials: S
authors.lastname: Holmes
authors.forename: D A L
authors.initials: DA
authors.lastname: Morgan
authors.forename: R W
authors.initials: RW
authors.lastname: Blamey
mesh_terms: D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000379:methods; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology*; D008408:Mastectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011788:Quality of Life; D011795:Surveys and Questionnaires