title: The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review.
abstract: Breast cancer-related lymphedema (BCRL) has become an increasingly important clinical issue as noted by the recent update of the 2015 NCCN breast cancer guidelines which recommends to "educate, monitor, and refer for lymphedema management." The purpose of this review was to examine the literature regarding early detection and management of BCRL in order to (1) better characterize the benefit of proactive surveillance and intervention, (2) clarify the optimal monitoring techniques, and (3) help better define patient groups most likely to benefit from surveillance programs. A Medline search was conducted for the years 1992-2015 to identify articles addressing early detection and management of BCRL. After an initial search, 127 articles were identified, with 13 of these studies focused on early intervention (three randomized (level of evidence 1), four prospective (level of evidence 2-3), six retrospective trials (level of evidence 4)). Data from two, small (n = 185 cases), randomized trials with limited follow-up demonstrated a benefit to early intervention (physiotherapy, manual lymphatic drainage) with regard to reducing the rate of chronic BCRL (>50% reduction) with two additional studies underway (n = 1280). These findings were confirmed by larger prospective and retrospective series. Several studies were identified that demonstrate that newer diagnostic modalities (bioimpedance spectroscopy, perometry) have increased sensitivity allowing for the earlier detection of BCRL. Current data support the development of surveillance programs geared toward the early detection and management of BCRL in part due to newer, more sensitive diagnostic modalities.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Arthur
authors.affiliation: Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts.|Department of Radiation Oncology, Brown University, Providence, Rhode Island.
authors.forename: David
authors.initials: D
authors.lastname: Wazer
authors.affiliation: Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sheila
authors.initials: S
authors.lastname: Ridner
authors.affiliation: Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan.
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
mesh_terms: D000072656:Breast Cancer Lymphedema / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
keywords: Breast cancer; detection; intervention; lymphedema; prevention