New Study Finds Prevalence of LE>40%

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kira66715
kira66715 Member Posts: 4,681
edited June 2014 in Lymphedema

This is an open access journal--I couldn't get the whole study to see how they defined LE, as we all know there's no single definition of it:

http://www.biomedcentral.com/1472-6874/13/6/abstract

Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil
Daniella MF Paiva, Vivian O Rodrigues, Marcelle G Cesca, Pamella V Palma and Isabel CG Leite

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BMC Women's Health 2013, 13:6 doi:10.1186/1472-6874-13-6

Published: 13 February 2013
Abstract (provisional)
Background
Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora.

Methods
We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of medical records was performed to select women who met the inclusion criteria as follows: women who had an operation more than 6 months ago; absence of active disease, locoregional or distant; the absence of functional change in the affected limb before surgery, which could lead to swelling of the limb; and simulating or masking symptoms of lymphedema, such as bursitis, tendonitis, and work-related musculoskeletal disorders. Women with bilateral breast cancer, absence of axillary intervention (partial or complete axillary dissection and/or SLN biopsy), active disease in the region, or lympho-venous alteration of the limb before surgery were excluded. Data were collected from the medical records of the selected cases, and they subsequently underwent an interview and a physical assessment.

Results
The prevalence of lymphedema was 44.8%. There were medical records on the presence of this condition in 5.4% of cases. With regard to shoulder joint mobility, restrictions on abduction movements, internal and external rotation, and anterior shoulder adduction were significantly associated with lymphedema. Variables, including the presence of seroma, vascular changes, time elapsed after surgery, episodes of redness in the extremities, and cuticle removal from the hand with pliers were considered as major associated factors for lymphedema (p<0.05).

Conclusions
The prevalence of 44.8% for lymphedema found in this study is considered to be relevant because it is a morbidity that produces psychological, physical, and functional damage in patients with this condition. The planning of health programs and services appropriate for the immediate postoperative treatment of women with breast cancer, and increasing the awareness of health professionals regarding the early diagnosis of lymphedema, can help minimize the morbidity of this disease.

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Comments

  • Marple
    Marple Member Posts: 19,143
    edited February 2013

    Thank you Kira.  I can't go back but if only...........I knew then what I know now.

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  • gardengumby
    gardengumby Member Posts: 7,305
    edited February 2013

    cuticle removal with pliers?????

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  • KS1
    KS1 Member Posts: 632
    edited February 2013

    I was able to get the article (but haven't had a chance to read it ...).  Here's a description of how LE was diagnosed:  

    "The physical examination was performed by only one evaluator, who was qualified and trained for this type of approach. The criterion for the diagnosis of lymphedema was obtained by perimetry with the use of a measuring tape, with measurements obtained after adjustment of the dominant arm and time since diagnosis [7,14]. Measurements were taken at seven points: at the inside of the elbow in the supine position (taken as the zero point), and three measurements above and below this point, at intervals of 7.0 cm. Lymphedema was characterized as when the difference between the affected limb and the contralateral (control) limb, using at least one measurement, was equal to or greater than 2.0 cm [7,12,14,17]."   KS1

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  • Binney4
    Binney4 Member Posts: 8,609
    edited February 2013

    Gumby, I believe the "pliers" part is a problem of the translation from the Portugese. At least I hope so!Surprised

    KS, thanks for the criteria. Sort of an alarming conclusion, yes?Frown
    Binney

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  • KS1
    KS1 Member Posts: 632
    edited February 2013

    Just a worrisome thought about relying solely on measurements as THE criterion for LE.  Given that many women with LE also have  functional impairments that limit the use of their LE arm, muscle mass of the LE would go down over time (being replaced by fibrosis and fluid), and muscle mass of the non-LE would go up.  So, it is possible that a woman could have no inter-arm volume difference, but have LE.  Similarly, a woman's measurements could remain constant over time even  though she has developed LE (as fluid & fibrosis replaces muscle).   KS1 

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  • kira66715
    kira66715 Member Posts: 4,681
    edited February 2013

    KS1--EXACTLY the problem. When Jane Armer studied 250 women for 10 years (it's still ongoing) she found the 2 cm discrepancy at one point to be least sensitive--91% of women met that criteria at some point in the journey. She discarded all measurements in the first three months after surgery. She has a perometer and found that to be the most sensitive, but it doesn't work for hands...

    AW Stanton published a great article in Journal of Lymphoedema where he said that measurements should not be the only criteria, and subtle skin changes, history and loss of anatomical landmarks (smoothing of boney prominences) should be utilized.

    I wouldn't make their criteria, as I wrap and my bad arm is smaller due to atrophy and wrapping. Yet I clearly have LE.

    I go again and again to the Andrea Cheville quote on bc.org:

    http://www.breastcancer.org/treatment/lymphedema/evaluation/diagnosis

    According to Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at Mayo Clinic, it’s important to look at the whole picture: not just size and volume measurements, but the appearance of the limb or other body part. “There is no one value or standard you can use to say, ‘OK, if you meet that you have lymphedema, and if you don’t, well then you don’t have it,’” says Dr. Cheville. “For example, there may be no size or volume changes in the arm, but you could have subtle hand swelling or pitting on the arm. So it’s important not to be too locked into arm measurements alone, as that can create a false sense of security. You also need to be watching the arm and looking for the loss of what we call ‘anatomic architecture’ — an inability to see the veins and tendons in the arm as clearly, or less pronounced knuckles, or skin that is less wrinkled and therefore looks younger.”

    I gave a talk on diagnosis in LE, and it's a clinical diagnosis. Looking for a gold standard, and there isn't one yet....

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  • toomuch
    toomuch Member Posts: 901
    edited February 2013

    Still, this study has a higher percentage of women with LE than BS in general are willing to recognize. It's probably still a gross under representation of the problem but it's a step in the right direction!

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