Global Collaboration Unveils Breakthrough Strategies to Prevent Breast Cancer-Related Arm Lymphedema

In a groundbreaking international effort, 64 global experts from 16 countries have joined forces to address the critical unmet need of breast cancer-related arm lymphedema (BCRAL), a distressing condition affecting millions of breast cancer survivors worldwide. The study, published in eClinicalMedicine, unveils evidence-based interventions that can significantly reduce the risk of lymphedema for those who have undergone lymph node damage or removal during cancer treatment.

Key Findings and Recommendations:

The comprehensive two-round international Delphi consensus process, conducted from February 27, 2023, to May 25, 2023, involved the insights of 55 experts in breast cancer care and research.

1. Identification of Risk Factors: The study identifies key risk factors such as axillary lymph node dissection, post-operative radiotherapy, relative within-arm volume increase one month after surgery, a higher number of lymph nodes dissected, and high body mass index.
2. Preventive Interventions: The expert panel recommends a personalized approach based on patients’ preferences, risk factors, and the expertise of the healthcare team. Strategies include prospective surveillance programs, prophylactic compression sleeves, axillary reverse mapping, and prophylactic lymphatic reconstruction.
3. Clinical Guidelines: The study provides clinical guidelines for axillary management in clinical T1–2, node-negative breast cancer patients with 1–2 positive sentinel lymph nodes. It advises against routine axillary lymph node dissection in patients receiving breast conservation therapy and suggests considering axillary radiation for those undergoing mastectomy.

Global Impact:

The collaboration involved researchers from Princess Margaret Hospital in Hong Kong, Flinders University, and the University of Toronto. The study, which reviewed data from over 60,000 patients, represents a crucial step toward enhancing the lives of breast cancer survivors globally.

Patient Perspective:

Breast cancer survivor Monique Bareham emphasizes the critical importance of effective management to prevent chronic lymphedema, stating that it significantly impacts patients’ quality of life. The research not only raises awareness but also addresses gaps in clinical understanding, providing hope for improved health outcomes for breast cancer survivors worldwide.

Co-senior Author’s Insight:

Professor Raymond Chan, Deputy Vice-Chancellor (Research) at Flinders University and co-senior author of the study, highlights that about half of patients with BCRAL develop the condition 12–30 months after surgery. The study’s evidence-based approaches consider various risk factors, treatment options, and healthcare provider expertise, ensuring effective interventions for all patients, regardless of their location.

Conclusion:

This groundbreaking research marks a significant milestone in the global fight against breast cancer-related arm lymphedema, offering tangible strategies and guidelines that can be confidently applied in clinical settings. The study’s findings provide hope for a brighter future for breast cancer survivors worldwide.

More information: Henry C.Y. Wong et al, Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations, eClinicalMedicine (2024). DOI: 10.1016/j.eclinm.2024.102441