Breast cancer related lymphoedema following treatment in the Edinburgh Breast Unit.

There is very little published data on the epidemiology of breast cancer related lymphoedema (BCRL) in the Scottish population. In Scotland, BCRL is treated by a variety of practitioners across the country and there is no national system to audit outcomes. With recent advances in lymphatic surgery and new guidance from NICE, there is a group of patients who could benefit from prophylactic lymphatic surgery at the time of their primary breast cancer excision. In this short communication we review 5 years of referrals to the lymphoedema unit attached to the Edinburgh Breast Unit. We show the rate of upper limb lymphoedema was 14.6% after oncological breast cancer surgery, and patients undergoing sentinel node biopsy and breast conserving surgery had a 3.3% risk of breast oedema. Importantly, during the process of data collection, we noted how patient records are often fragmented across several electronic and paper record systems. There is a clear need here for a national managed audit network which would enable accurate data collection across health boards and could be used to monitor outcomes of lymphoedema therapy and lymphatic surgery. We suggest, to begin with lymphoedema data could be added to the cancer audit network QPI's (quality performance indicators). This would allow annual assessment of patient outcomes in a rapidly changing surgical field.