Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer.
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.
Rampaul
R S
RS
Breast Cancer Unit, Nottingham City Hospital, Nottingham NG1 5PB, UK. mszrsr@msn1.surgery.nottingham.ac.uk
Mullinger
K
K
Macmillan
R D
RD
Cid
J
J
Holmes
S
S
Morgan
D A L
DA
Blamey
R W
RW
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