Expert Point of View: Michael Berry, MD

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Michael Berry, MD, a breast surgeon who is Director of the Margaret West Comprehensive Breast Center at The West Cancer Center, Memphis, told the The ASCO Post that these findings “echo what surgeons already know,” which is that lymphedema is a result of multiple insults to the axilla. But one surprising finding, he added, was the risk associated with the use of taxanes. “I think medical oncologists will be pretty shocked that their choice of chemotherapy has an effect,” he offered.

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Although the often-quoted figure is that some 30% of women will develop lymphedema after axillary lymph node dissection, the number in this study was lower—15.9%—which is probably more accurate and reflects the use of less-aggressive approaches, he said.

“Surgeons are doing less ‘full skeletalization,’” noted Dr. Berry. “We used to overdo surgical treatment, and it could have devastating results. We’ve gotten away from this. There is still a need for staging and removal of bulky nodes, but we don’t wipe out the whole axilla.”

“There are also instances where we can avoid the radiation that compounds the risk,” he added, explaining that some patients receive full axillary radiation, where the radiation oncologist could be “a lot more selective.” In some instances, he continued, radiation can take the place of axillary dissection, based on results of the AMAROS trial, showing this to be safe in select women with up to three positive nodes.

Update on Risk Factors

Lymphedema is most common in women who have axillary lymph node dissection, radiotherapy, a body mass index > 25 kg/m2, and a history of cellulitis in the arm. Other factors once believed to contribute—such as blood draws, heavy lifting, and a host of other things—have no correlation, Dr. Berry said.

It is important for women deemed to be a high risk for lymphedema not to wait until the condition emerges. “If you are detecting it clinically, that’s not good. You can’t reverse it,” he pointed out. The use of bioimpedance spectroscopy can aid in early detection. “There may be a point in time where if you catch it subclinically, you may be able to reverse it.” ■

Disclosure: Dr. Berry reported no conflicts of interest.

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In a study from the Mayo Clinic, Rochester, Minnesota, the risk of lymphedema in a population-based breast cancer cohort was related to multimodality therapy and not axillary surgery alone,...