Breast Cancer Survivors Often Meet Multiple Criteria for Lymphedema.

Abstract

Abstract Introduction:Assessment and diagnosis of lymphedema (LE) has been problematic, in part due to the fact that various measurement approaches and criteria have been applied. This analysis examines four different criteria for diagnosing lymphedema among breast cancer survivors. Recent scientific literature reports that anywhere from 6 to 30 percent (Petrek and Heelan, 1998) or 6 to 62.5 percent (Passik, 1998) of the breast cancer population has LE. The discrepancies among the reported percentages stem from difficulties in measurement, diagnosis, and follow-up (Petrek and Heelan, 1998, Passik, 1998, Rockson, 1998, Meek, 1998, Armer and Stewart, 2005, Hayes et al., 2008). Traditionally, finding >2cm difference in limb girth between the affected and non-affected limbs warranted clinical diagnosis of LE (Callaway, 1988, Armer and Stewart, 2005). Measuring a 200 ml limb volume difference or a 10 percent limb volume change (LVC) from baseline and/or between limbs as well as self-reported signs and symptoms are also documented methods of LE diagnosis (Petlund, 1991, Armer and Stewart, 2005).Methods:Participants were enrolled post-breast cancer diagnosis but pre-surgery, and followed every 3 months for 12 months, then every 6 months until 2.5 years post-surgery. Limb volume changes (LVC) were measured using: (a) circumferences via tape measure at 4 cm intervals, (b) infra-red laser perometry, and (c) symptom experience (SS) via interview. Four diagnostic criteria for LE were used: (i) 2cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) self-report of limb heaviness/swelling.Results:In this cohort, 84% met at least one criterion to identify lymphedema by 2.5 years post-treatment (Figure 1). The most common single criterion met was 2-cm circumferential change (25%). When examining meeting multiple criteria, 13% of participants met the combination of 200mL LVC, 10% LVC, and 2cm change. In addition, 11% of participants met all four lymphedema criteria by 2.5 years post treatment.Conclusions:This analysis demonstrates breast cancer survivors who develop lymphedema often meet multiple criteria for the condition. We found 62% of those with lymphedema met two or more criteria used in this analysis, and 31% met three or more criteria. The most common criterion to identify lymphedema, either alone or associated with one or more criteria, was 2 cm circumference change (77%), while 10% LVC was least likely to be met (26%). Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2074.