title: Preoperative assessment enables the early diagnosis and successful treatment of lymphedema.
abstract: BACKGROUND
  The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE.
  
  
  METHODS
  LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase>3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measures analysis of variance by time and limb (P<or=.001) comparing the LE cohort with an age-matched control group.
  
  
  RESULTS
  The time to onset of LE averaged 6.9 months postoperatively. The mean (+/-standard deviation) affected limb volume increase was 83 mL (+/-119 mL; 6.5%+/-9.9%) at LE onset (P=.005) compared with baseline. After the intervention, a statistically significant mean 48 mL (+/-103 mL; 4.1%+/-8.8%) volume decrease was realized (P<.0001). The mean duration of the intervention was 4.4 weeks (+/-2.9 weeks). Volume reduction was maintained at an average follow-up of 4.8 months (+/-4.1 months) after the intervention.
  
  
  CONCLUSIONS
  A short trial of compression garments effectively treated subclinical LE.
authors.affiliation: Breast Cancer Department, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA. nicole.stout@med.navy.mil
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Stout Gergich
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Pfalzer
authors.forename: Charles
authors.initials: C
authors.lastname: McGarvey
authors.forename: Barbara
authors.initials: B
authors.lastname: Springer
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
authors.forename: Peter
authors.initials: P
authors.lastname: Soballe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications*; D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D008875:Middle Aged; D011300:Preoperative Care