The prevalence of Lymphedema and changes in practice to reduce its occurrence in women with breast cancer

Lymphedema is a chronic debilitating condition affecting many long-term breast cancer survivors. The incidence of lymphedema is reported to range from 6% to 70% after axillary surgery for breast cancer; however, its true incidence has been difficult to quantify because of the lack of standard diagnostic and universal assessment criteria. Extent of nodal dissection, axillary radiation, injury, and infection in the ipsilateral upper extremity remain significant risk factors for the development of lymphedema. Current changes in axillary management, including the adoption of sentinel node biopsy, the selective omission of completion axillary dissection after a positive sentinel node, and the elimination of axillary staging, have been proposed to further reduce axillary morbidity. Early research on lymphedema risk reduction focuses on supervised weight training after axillary surgery, axillary reverse mapping to avoid removal of lymph nodes draining the upper extremity, and incorporation of fused single photon emission computed tomography (SPECT)-CT axillary nodal images to better plan adjuvant radiation treatments.