The increasing role of breast cancer lymphedema screening, diagnosis, and management as part of evidence-based breast cancer survivorship.

Abstract

145 Background: With improved outcomes across all stages, breast cancer survivorship represents an increasingly significant oncologic issue. One major facet of breast cancer survivorship is assessment and management of sequelae of treatment including breast cancer related lymphedema (BCRL) which has an incidence of 5-40% depending on locoregional and systemic treatment. BCRL represents a complication associated with physical changes as well as reduction in quality of life and continues to increase in prevalence with new diagnostics (ex. L-Dex, perometry) increasing the sensitivity for detection. Methods: Review of current evidence based guidelines from the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and the American Cancer Society. Results: Evidence based treatment guidelines for breast cancer have evolved in 2015. For the first time, the NCCN guidelines include a reference to BCRL as part of routine treatment stating “to educate, monitor, and refer for lymphedema management” represents a standard component of breast cancer treatment and survivorship and allows for the early diagnosis and treatment of BCRL. At this time, neither the ASCO Breast Cancer nor ASCO survivorship guidelines incorporate BCRL management into routine practice. At this time, BCRL management is not part of ACS survivorship protocols. Conclusions: At this time, due to increasing data on BCRL diagnosis and treatment, evidence based guidelines are beginning to incorporate BCRL education, diagnosis, and treatment into standard breast cancer management plans. With increasing focus on survivorship, prospective BCRL programs are being developed that begin evaluation prior to treatment with screening in place and early intervention to help prevent progression by using diagnostics with increased sensitivity (ex. L-Dex, perometry).