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Quick Links:
National Lymphedema Network [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1AiygFe9VynH3HXj0SARRXQ9Oz_KkKKk_GsCbhmjML1RFPCkBP7M9_3qOS_b7451sEekpNv-oSb5lKSwTwpohYeWUyLAq7MLZVEc=]
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Position Papers:
NEW! Supplement: Breast Cancer Related LE Screening Position [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1Aiwy3rBfizFfFYX0vtyVKqeBMKZYYdmtMedR3Ktum7l1nFFmx0kbdrMYGNLcHXTcWjJ5PucwKMaWs3RfvhXoQqY_OlYx7PzQueSZNKW7rxJmcBtMLSxpZKrY65AbAFNTqQVcXTjZhfan33qZvH8fTPLtu7e2iczzhVI=]
Diagnosis & Treatment of Lymphedema [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1Aiy2iKBC7g_xvqIGm5CPsTGpvv6iyp4sqg5JkYJ5c1gQd1Xw9dROfyRye1eHnKaU7anoIeGNLDtHOaLPY5D2Lv9jEYaB9EwOam_VVSxZg5kOQ6yArvQ_osgKFCxHv2G-E2iJTrJDEMJDwA==]
Breast Cancer Related Lymphedema [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1AiyCQsodSOnOb-GwleRJfl7U3uWinaK3qlgwBophr585DMrLLFuMoWmqb_TAYUGK8CaSPYcGONyeopOX-StGKbPwb5Laylnu8M4EMoxLx6qW8GWl8UFY-LJwiKYITM12ARk=]
Risk Reduction [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1AiyKSI0Vn5km879GYkDoDZWChnyeSMeg7bMgo2KM4HBYhU_mxXDirPGzYVpleOb62F-HoCco0VrCYFB6ND5ECcIhI_wwGLP8NugsTDjJD9Ucpspu8AnHRRNwnqgnhkEuNjGQ7jXE4hkKPQ==]
Exercise [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1Aizw8j9s3LIki2ZalEsFe00x_AGyDJlQTPoqPw5jG-1ak6XyOxTZHK2bLlt1QvHfyhflCYtzCuKq_XqLSZSUZu32jS2tNjWeSXNAK39bcLJ9FD7umXDF2T9Npp7ojzEfy9w=]
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Dear lymphedema treatment,
In response to an article published in the March issue of the Journal Of American
College of Surgeons (http://www.journalacs.org/article/S1072-7515(12)01312-9/abstract)
[http://r20.rs6.net/tn.jsp?e=001nhpMO-a1AiwJSeozty0iT6YItFJRrry2J4c-pXnJvg3m59tRX6FdvpuI39utF_jzLcrDHP3sxmm0-RNFa-5eoLTMlQm4K20PB8F0KlKKrY1k9hWQ7I4SfKPejxxspkkC0JhTLJ5T3TDt6ZDCfndui6Sr-ft8eog7X5DHfXkR9S0dFuemxTKHLw==]
the NLN Medical Advisory Committee is responding to a Press Release released on
February 25, 2013 (http://www.facs.org/news/jacs/lymphedema0313.html [http://r20.rs6.net/tn.jsp?e=001nhpMO-a1Aiwhf-ZWTELzGQfaPPx5k3aSkQAMK7SJH2EgVP-OQviq56ode8ZMTC4jxDipo6NOoCD8-X9_XLdwPXv3z9ouXrtWlKZaJuzo1yrZev8zoswHCFiaeChWW_UXT33rt9UhZCmrJ5dQgS5pCA==])
in the Journal of American College of Surgeons, "Breast Cancer Patients Fear for
Developing Lymphedema Far Exceeds the Risk "
Respectfully:
Saskia R.J. Thiadens RN
Executive Director
March 1, 2013
On 2/25/2013 the Journal of American College of Surgeons released a statement entitled,
"Breast Cancer Patients' Fear of Developing Lymphedema Far Exceeds the Risk." The
press release was in response to findings from a single-site study published in
the March issue of the Journal of the American College of Surgeons noting that some
breast cancer survivors take extraordinary measures to try to prevent lymphedema
that may not be necessary. The rate of development of lymphedema in the limbs of
the study patients (N=120, followed to 12 months) was similar to reported incidence
in the medical literature. Three percent of patients having a sentinel lymph node
biopsy developed lymphedema and 19% of patients having an axillary lymph node dissection
developed lymphedema. The study indicated that patients with sentinel lymph node
biopsy worried and took precautions as much as those who had axillary node dissections.
The National Lymphedema Network agrees with the statement in the press release that
"future research should be aimed at better predicting which women will develop lymphedema,
thus allowing for targeted prevention and intervention strategies and individualized
plans for risk-reducing behaviors for each woman during and after her breast cancer
treatment." However, since this type of risk stratification and broad education
does not currently exist, it is important for patients to be given accurate information
by their doctors and oncology care providers on reasonable approaches to reducing
the risk of developing lymphedema.
The American Cancer Society estimates that in 2013 there will be about 232, 340
new cases of breast cancer in the US and there are approximately 2.9 million breast
cancer survivors in the US. If 20% of those who have axillary dissections, and,
conservatively, 3% with sentinel lymph node biopsies, are at risk of developing
lymphedema, this is still a very large number of women who have reason to be concerned
about their risk of developing lymphedema.
Lymphedema is a progressive, debilitating condition that is not merely swelling,
but an immune system dysfunction. When recognized late in its course, or inadequately
treated, lymphedema leads to chronic infection and progressive disability. Women
who are at risk for lymphedema have reason to be concerned and these concerns should
not be minimized.
The National Lymphedema Network advocates a reasonable approach to risk reduction
guidelines, given that a large population of women is still at significant risk
of developing lymphedema. In the NLN Position Paper on Risk Reduction, revised in
2012 and available at www.lymphnet.org , a risk stratification approach is detailed
so patients can take appropriate precautions according to their medical situation.
Every breast cancer survivor deserves accurate information about her or his risk
of developing lymphedema and reasonable precautions based on the available scientific
evidence.
The American College of Surgeons, and all providers of care to breast cancer patients,
are encouraged to provide every breast cancer patient with accurate information
about lymphedema, so patients can make informed choices. Given the imperfect state
of the science on risk reduction for lymphedema, there are many reasonable, healthy
suggestions for patients at risk of lymphedema to reduce their risk, such as weight
management and exercise. The Position Papers on the NLN website on Exercise, Risk
Reduction and Screening for Breast Cancer Related Lymphedema were written by a panel
of medical experts in the field of lymphology and lymphedema treatment.
The National Lymphedema Network urges the American College of Surgeons to endorse
the NLN Position papers, provide them to their members, and acknowledge that a large
number of breast cancer survivors are at risk of or currently have lymphedema. These
patients need education and information that will allow them to take precautions
that are reasonable and not excessive. Education is the key and then what each
one does with that information is a personal choice and a part of personalized
health care.
Respectfully,
NLN Medical Advisory Committee
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National Lymphedema Network, Inc.
116 New Montgomery Street, Suite 235
San Francisco, CA 94105
Hotline: 1.800.541.3259
Tel: 415.908.3681
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