Arm swelling common among young breast cancer patients
COLUMBUS , Ohio – The good news is that there are nearly two million breast cancer survivors in the United States , and survival rates continue to increase for patients with this disease. But the flip side is that survival can present its own set of little-known complications.
Researchers found that slightly more than half of 580 women diagnosed with breast cancer in one study experienced swelling, or lymphedema, in their arms or hands after the surgical removal of the breast or the tumor.
This swelling was persistent among nearly one-third of the women. Women with lymphedema reported their quality of life as lower than did women without the problem.
"Women don't know about lymphedema," said Electra Paskett, the study's lead author and a professor of epidemiology and biostatistics in the School of Public Health at Ohio State University .
"When a breast cancer survivor has swelling in her arm, she may immediately think that her cancer has come back," she continued. "And the swelling, which may occur at any time, is a constant reminder of having had cancer."
For most women, the swelling takes place on the same side of the body as the affected breast. And it's generally not a sign of cancer's recurrence, Paskett said.
Lymphedema can be painful, as the arm becomes fluid-filled, heavy and stiff and the skin becomes tight. Affected patients may have problems using their arms or hands. They also often need to buy clothes that are otherwise too big in order to fit the swollen limb.
Lymphedema is caused by a build-up of lymphatic fluid. The lymphatic system serves as a source of immune cells and includes organs and tissues such as bone marrow, the spleen, and lymph nodes. Lymph nodes are small, round masses of tissue that filter lymphatic fluid and can also trap cancer or bacteria cells that flow through the blood.
Removing or sampling the lymph nodes during surgery is fairly common, as they can serve as a conduit by which cancer can spread throughout the body. Both lymph node removal and radiation can disrupt the flow of lymph fluid.
"The lymph system is like a freeway," Paskett said. "If there is construction or a wreck, all of the cars back up. That's sort of what happens with lymphedema – there is a traffic jam, and the fluid gathers in the arm, hand and fingers."
She presented the findings on June 11 in Philadelphia at the U.S. Department of Defense's Breast Cancer Research Program 2005 'Era of Hope' Meeting.
This research is part of a larger national study called the Menstrual Cycle Maintenance and Quality of Life study. The overarching goal of this larger study is to see if young women who undergo chemotherapy can get pregnant, and if they can, what effect pregnancy may have on breast cancer recurrence.
The participants were recruited between 1998 and 2001. For the lymphedema analysis, Paskett and her colleagues examined the data from 580 women who were surveyed every six to 12 months over a three-year period. The women in this study were 18 to 45 years old at the time of their breast cancer diagnosis.
All of the women in the study were diagnosed with either stage 1, 2 or 3 breast cancer – all of the cancers were localized, meaning that tumors had not spread throughout the body.
About half (55 percent, or 319) of the women reported arm and/or hand swelling at some point within three years after joining the study. About a third (29 percent, or 168) of the women reported persistent swelling sometime during the follow-up period.
The researchers aren't sure exactly why this swelling happens to some women and not to others. But the problem was more prevalent in women who had a higher number of lymph nodes removed during surgery. Curiously, being married was associated with an increased chance of having lymphedema, although the researchers don't know why.
Women who reported arm or hand swelling also reported having a lower health-related quality of life.
While there is no cure for lymphedema, swelling can be reduced through massage or by wearing a compression garment. The latter is a tight sleeve or glove that forces lymph fluid out of the hand and arm and back into the body.
"Lymphedema can occur anywhere that lymph nodes are either removed or treated with radiation therapy," Paskett said.
She conducted the study with Jill Abbott, a program manager at Ohio State's Comprehensive Cancer Center; Michelle Naughton and Thomas McCoy, both with the Wake Forest University School of Medicine; and Jeanne Petrek, formerly of Memorial-Sloan Kettering Cancer Center in New York. Petrek, who started the Menstrual Cycle Maintenance and Quality of Life study, passed away earlier this year, Paskett said.
This work was supported by the U.S. Army Medical Research and Materiel Command.