Preoperative assessment enables the early diagnosis and successful treatment of lymphedema

BACKGROUND. The incidence of breast cancer (BC)-related lymphedema (LE) ranges from 7% to 47%. Successful management of LE relies on early diagnosis using sensitive measurement techniques. In the current study, the authors demonstrated the effectiveness of a surveillance program that included preoperative limb volume measurement and interval postoperative follow-up to detect and treat subclinical LE. METHODS. LE was identified in 43 of 196 women who participated in a prospective BC morbidity trial. Limb volume was measured preoperatively and at 3-month intervals after surgery. If an increase >3% in upper limb (UL) volume developed compared with the preoperative volume, then a diagnosis of LE was made, and a compression garment intervention was prescribed for 4 weeks. Upon reduction of LE, garment wear was continued only during strenuous activity, with symptoms of heaviness, or with visible swelling. Women returned to the 3-month interval surveillance pathway. Statistical analysis was a repeated-measores analysis of variance by time and limb (P <= .001) comparing the LE cohort with an age-matched control group. RESULTS. The time to onset of LE averaged 6.9 months postoperatively. The mean (+/- standard deviation) affected limb volume increase was 83 mL (+/- 119 mL; 6.5% +/- 9.9%) at LE onset (P = .005) compared with baseline. After the intervention, a statistically significant mean 48 mL (+/- 103 mL; 4.1% +/- 8.8%) volume decrease was realized (P < .0001). The mean duration of the intervention was 4.4 weeks (+/- 2.9 weeks). Volume reduction was maintained at an average follow-up of 4.8 months (+/- 4.1 months) after the intervention. CONCLUSIONS. A short trial of compression garments effectively treated subclinical LE.