An Increased Risk of Arm Morbidity in Breast Cancer Patients

Nurse Assisting Patient Undergoing Mammogram

This year’s San Antonio Breast Cancer Symposium (SABCS) is shedding light on many of the pressing challenges in breast cancer treatment. On Friday December 8th, an interesting presentation regarding the increased risk of arm morbidity that may be seen after lymph node surgery for younger women with breast cancer.

Arm Morbidity and Quality of Life
Arm morbidity related symptoms include arm swelling, a decreased range of motion, or other symptoms that make it difficult to do activities related to arm movement.

These symptoms can commonly occur in breast cancer patients after certain treatments and procedures, and arm morbidity is associated with a significantly negative impact on a patient’s lives.

While breast cancer survivors can be helped by rehabilitation programs that exist to improve their functional well-being, they are often still highly limited in the activities they can participate in, which has been shown to detrimentally impact Quality of Life (QOL). [1]

Many breast cancer patients undergo axillary surgery as a way of checking for breast cancer spreading to nearby lymph nodes. The traditional procedure for this is called Axillary Lymph Node Dissection, or ALND. Recently, a procedure called Sentinel Lymph Node Biopsy or SLNB, which is a less extensive and less invasive procedure than ALND, has been shown to be safe in selected breast cancer patients who have had little or no nodal involvement detected at their diagnosis stage.

Risk Increase with ALND
In Friday’s presentation, a study funded by the National Institutes of Health, the Susan G. Komen Foundation, The Pink Agenda, and The Breast Cancer Researcher Foundation wanted to compare the likeliness of arm morbidity in younger breast cancer patients that have undergone either ALND or SLNB. To do so, reports were examined from 1,302 women aged 40 or younger, who were taking part in the Young Women’s Breast Cancer Study.

Using the criteria from the Cancer Rehabilitation Evaluation System, researchers examined incidence of arm swelling or decreased range of motion as reported by the patient one year after their diagnosis. In this study, 55% of the women had undergone SLNB, and 41% had undergone ALND. Of this patient group, those who had undergone a lumpectomy, a breast conserving surgery to remove tumor cells while leaving as much normal breast behind as possible, showed a 6% incidence of arm swelling if they had undergone SLNB, and 24% if they had received ALND. In patients who underwent a unilateral or bilateral mastectomy, a removal of the breast entirely, the results were similar, with a 6% incidence of arm swelling in the SLNB group, and 23% in the ALND group. [2][3]

The study’s lead author, Anne Kuijer, PhD, postdoctoral research fellow at Dana-Farber Cancer Institute/Brigham and Women’s Hospital, explained that the study highlights the importance of de-escalading axillary treatment when appropriate in breast cancer patients, especially when conservative surgeries are showing effective long term results.

“These issues are of particular importance in these patients given their long survivorship period, frequently active lifestyle, and the importance of body image,” Kuijer said.

Other take-aways
Other important take-aways from this study were certain factors that were associated with an increased risk of arm morbidity. For example, being overweight at the time of diagnosis increased the risk significantly. Additionally, financial status of the patient also showed a correlation, as patients who described themselves as financially comfortable were less likely to report arm-swelling compared to those who did not.

“This highlights the importance of ensuring adequate social support and resources for young patients undergoing breast cancer.” Kuijer concluded. [3]


Last Editorial Review: December 8, 2017

Featured Image: Nurse and Breast Cancer patient. Courtesy: © Fotolia | Used with permission.

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