Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis.
Precautionary recommendations conveyed to survivors of cancer by health-care practitioners to reduce the risk of breast cancer-related lymphoedema are indispensable aspects of clinical care, yet remain unsubstantiated by high-level scientific evidence. By reviewing the literature, we identified 31 original research articles that examined whether lifestyle-associated risk factors (air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and skin infections-eg, cellulitis) increase the risk of breast cancer-related lymphoedema. Among the few studies that lend support to precautionary guidelines, most provide low-level (levels 3-5) or inconclusive evidence of an association between lymphoedema and these risk factors, and only four level 2 studies show a significant association. Skin infections and previous infection or inflammation on the ipsilateral arm were among the most clearly defined and well established risk factors for lymphoedema. The paucity of high-level evidence and the conflicting nature of the existing literature make it difficult to establish definitive predictive factors for breast cancer-related lymphoedema, which could be a considerable source of patient distress and anxiety. Along with further research into these risk factors, continued discussion regarding modification of the guidelines and adoption of a risk-adjusted approach is needed.
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Maria S
MS
Asdourian
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Melissa N
MN
Skolny
Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cheryl
C
Brunelle
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cara E
CE
Seward
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Laura
L
Salama
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ataghian@partners.org.
Alphonse G
AG
Taghian
D064870:Air Travel; D001794:Blood Pressure; D000072656:Breast Cancer Lymphedema / Q000209:etiology / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000150:complications* / Q000628:therapy; D002481:Cellulitis / Q000469:parasitology*; D004322:Drainage; D005260:Female; D006801:Humans; D011677:Punctures; D012307:Risk Factors; D012867:Skin / Q000293:injuries*; D017741:Survivors; D013696:Temperature