Abstract
There has been an increasing call to prospectively screen patients with breast cancer for the development of breast cancer-related lymphedema (BCRL) following their breast cancer treatment. While the components of a prospective screening program have been published, some centers struggle with how to initiate, establish, and sustain a screening program of their own. The intent of this manuscript is to share our experience and struggles in establishing a prospective surveillance program within the infrastructure of our institution. It is our hope that by sharing our history other centers can learn from our mistakes and successes to better design their own prospective screening program to best serve their patient population.
Highlights
As the long-term survival rate for breast cancer patients improves, there is an increasing focus on helping survivors manage the sequelae of breast cancer treatment that may affect function and/or quality of life
Previous analyses of our patient population has suggested that individuals who undergo axillary lymph node dissection (ALND), regional lymph node radiation (RLNR) or have a high BMI at the time of their breast cancer diagnosis are more likely to develop breast cancer-related lymphedema (BCRL) [3,4,5]
Patients whose arm volume remains elevated and/or are having symptoms of BCRL are referred to their oncologists for further assessment and consideration of a Certified Lymphedema Therapist (CLT) consult
Summary
As the long-term survival rate for breast cancer patients improves, there is an increasing focus on helping survivors manage the sequelae of breast cancer treatment that may affect function and/or quality of life. It has been our experience at Massachusetts General Hospital that a prospective surveillance model for BCRL is both feasible and sustainable Such a screening program, in which patients are continuously monitored for arm volume changes via perometer measurements preoperatively and every few months postoperatively, was implemented at our institution several years ago. Given the commitment of the team, they were able to secure a small space (7.5 × 5 feet or 2.3 × 1.5 m) within the Breast Center that could house the perometer (Figure 1) This centralized location was ideal as it was within close proximity to the breast cancer patients who were seeing their oncology providers in the clinic. Efforts can be made to improve the accuracy of each measurement method by standardizing measurement protocols
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