Analysis From Large, Prospective Randomized Trial Finds Need for Ongoing Lymphedema Surveillance

A recent study found that patients can be diagnosed with lymphedema throughout the first three years following breast cancer treatment. This was based on a secondary analysis of the PREVENT trial, which previously demonstrated prospective lymphedema surveillance with bioimpedance spectroscopy coupled with early intervention can better help prevent lymphedema from becoming a chronic condition.

Between three to five million patients worldwide contract breast cancer-related lymphedema (BCRL) each year. If the condition isn’t found early, it can be challenging to manage and may require aggressive treatment such as complex decongestive physiotherapy, lymphovenous bypass surgery or lymph node transfer procedures.

Study details

In this secondary analysis of the PREVENT randomized trial, researchers followed 900 women after breast cancer treatment to determine rates of subclinical breast cancer-related lymphedema (sBCRL) as well as progression to chronic lymphedema (cBCRL).

Women enrolled were followed on a regular basis for up to 36 months after breast cancer treatment, using either bioimpedance spectroscopy or tape measure. Those diagnosed with sBCRL were prescribed early intervention with a compression sleeve for four weeks.

Study results

“More than half of patients who developed subclinical lymphedema did so within nine months of finishing breast cancer treatment,” explains Chirag Shah, MD, Co-Director of the Comprehensive Breast Program and Director of Breast Radiation Oncology at Cleveland Clinic Cancer Institute. “But what we also saw is that patients, regardless of lymphedema screening method, continued to develop subclinical lymphedema up to three years out from treatment. This data supports the need for continued surveillance for lymphedema as part of breast cancer follow-up and survivorship.”

Key findings

The PREVENT trial and this secondary analysis found patients continue to be at risk of BCRL years after surgery. In addition, early detection of sBCRL with bioimpedance coupled with early intervention reduced the chances of progressing to cBCRL compared with tape measure (7.9% vs. 19.2%). Based on these findings, researchers and clinicians recommend that patients be monitored for years following completion of cancer treatment. In particular, careful monitoring over the first nine-month period is essential.

Several prospective studies, as well as the PREVENT randomized trial, support that bioimpedance spectroscopy allows for early detection and intervention, which can prevent cBCRL. The study data also validates prospective surveillance models for lymphedema coupled with early intervention with something as simple as a compressive sleeve to reduce rates of chronic lymphedema.

“In the past, clinicians waited until a patient developed symptoms of lymphedema before intervening,” says Dr. Shah. “For many disease states, we’re learning that by intervening early before there are clinical symptoms, we get better outcomes, with less aggressive interventions.”

All breast cancer patients – regardless of their risk category – should be considered for lymphedema surveillance, with those at highest risk monitored closely for at least three years after completing breast cancer treatment. This way if subclinical lymphedema develops, it can be addressed quickly.