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Originally published as JCO Early Release 10.1200/JCO.2009.22.3388 on May 4 2009 © 2009 American Society of Clinical Oncology.
Lymphedema Following Breast CancerQueensland University of Technology, Kelvin Grove, Queensland, Australia To the Editor: Lymphedema—a chronic, disabling sequela of breast cancer treatment—is finally receiving the research attention it deserves. The work published by Norman et al1 in the January issue of Journal of Clinical Oncology supports the findings of this emerging literature, which demonstrates that lymphedema is common following breast cancer treatment, but that higher estimates are observed when self-report is used to assess lymphedema status compared with other measures such as circumferences, perometry, or bio-impedance spectroscopy. While Norman et al reported that the majority of cases occur within 2 years of diagnosis, work by us2 and others3 have demonstrated that the majority of cases (70% to 80%) occur within the first 12 months after diagnosis. Collectively, this work advocates for the measurement of lymphedema being included within routine presurgical and postsurgical care. However, until we know more about the effectiveness of lymphedema treatment, clinicians may remain skeptical about active screening for lymphedema. Anecdotally, the intermittent and fluctuating nature of lymphedema exemplified in the self-reports within the study sample by Norman et al1 has been known, but lacks scientific documentation. Using bio-impedance spectroscopy,2 we demonstrated that 60% of women with lymphedema between 6 and 18 months after diagnosis experienced transitory symptoms, whereby the lymphedema dissipated with or without treatment. However, in 40% of those who ever experienced lymphedema the symptoms were chronic, lasting for longer than 3 months with or without intermittent periods of relief. Unfortunately, our data collection methods did not capture lymphedema treatment, and we were therefore unable to assess the relationship between receipt of treatment and the fluctuation in lymphedema. The work by Norman et al1 is particularly exciting because they appear to have adequate numbers and appropriate data to allow for relevant extension of their analyses on duration, severity, and progression of lymphedema. Of particular clinical interest is whether those women who received treatment were more likely to experience improvements in their lymphedema or whether fluctuations in lymphedema status (improvement or worsening) occurred irrespective of treatment. For example, Norman et al1 indicated that those with mild lymphedema were three times more likely to develop moderate/severe lymphedema when compared with women without lymphedema. Was this relationship attenuated when treatment was received, or alternatively, was risk of progression exacerbated when treatment was not received? The results of such additional analyses will be of significant benefit to breast cancer clinicians, lymphedema therapists, and researchers, and we look forward to hearing a response from Norman et al.1 AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Norman SA, Localio AR, Potashnik SL, et al: Lymphedema in breast cancer survivors: Incidence, degree, time-course, treatment, and symptoms. J Clin Oncol 27:390–397, 2009. 2. Hayes SC, Janda M, Cornish B, Battistutta D, et al: Lymphedema following breast cancer: Incidence, risk factors, and effect on upper-body function. J Clin Oncol 26:3536–3542, 2008. 3. Clark B, Sitzia J, Harlow W: Incidence and risk of arm oedema following treatment for breast cancer: A three-year follow-up study. QJM 98:343–348, 2005.
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Copyright © 2009 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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