Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: a guide for primary care providers.

PURPOSE: To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists.

DATA SOURCES: Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines.

CONCLUSIONS

LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians.

IMPLICATIONS FOR PRACTICE: A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment.