Precautions for breast cancer related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis.
Precautionary recommendations conveyed to survivors of cancer by health care practitioners to reduce the risk of breast cancer related lymphoedema are indispensable aspects of clinical care, yet remain unsubstantiated by high level scientific evidence. By reviewing the literature, we identified 31 original research articles that examined whether lifestyle associated risk factors (air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and skin infections eg, cellulitis) increase the risk of breast cancer related lymphoedema. Among the few studies that lend support to precautionary guidelines, most provide low level (levels 3 5) or inconclusive evidence of an association between lymphoedema and these risk factors, and only four level 2 studies show a significant association. Skin infections and previous infection or inflammation on the ipsilateral arm were among the most clearly defined and well established risk factors for lymphoedema. The paucity of high level evidence and the conflicting nature of the existing literature make it difficult to establish definitive predictive factors for breast cancer related lymphoedema, which could be a considerable source of patient distress and anxiety. Along with further research into these risk factors, continued discussion regarding modification of the guidelines and adoption of a risk adjusted approach is needed.
The Lancet. Oncology