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CMAJ
CMAJ - June 2, 1998JAMC - le 2 juin 1998

More on breast cancer guidelines

CMAJ 1998;158:1426

See response from: M. McGregor
The clinical practice guidelines for breast cancer are admirable, but the document lacks one vital section. A common complication of breast cancer treatment is post-mastectomy lymphedema. This problem can be disturbing, debilitating and dangerous. Because of its late onset it can come as a shock to the woman who feels that she has survived the disease. Although there is a great deal of conjecture as to the causes, no clear mechanism has been identified. It has been suggested that it results from chronic inflammation in the lymphatic or venous channels.1 Another school blames post-radiation changes,2 although radiation techniques have been modified considerably over the past few years and the condition is seen in patients who have not undergone radiotherapy. Others feel that it is always associated with invasion of the lymphatic nodes. Some claim that minor damage to superficial lymphatics or back-pressure on the lymphatic nodes, with production of a high-protein lymph, is the cause.3

A recently completed 10-year study at the Princess Margaret Hospital indicates that for 60% of patients, relatively good reduction of the swelling can be achieved with peripheral compression pumps and binding.4 However, the findings have been contested by practitioners who maintain that the pump is contraindicated and that manual lymphatic drainage is the key tactic.

Although it will be of little consolation to affected women, there may be some solace in the realization that because of its prevalence, interest in this condition has been rekindled and research reactivated.

Charles M. Godfrey, MA, MD
Professor Emeritus
University of Toronto
Toronto, Ont.

References

  1. McMaster PD, Hudack SS. Induced alterations in the permeability of the lymphatic capillary. J Exp Med 1932;56:239-53.
  2. Rubin P. Radiation toxicology. Cancer 1977;39:729-36.
  3. Casley-Smith JR. Endothelial permeability. The passage of particles through the lymphatic endothelium of the normal and injured ears. Br J Exp Pathol 1965;46:25-49.
  4. Godfrey C. A long-term follow-up treatment of post-mastectomy lymphedema. Royal College of Physicians and Surgeons of Canada meeting; 1996; Halifax.

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