Early Referral for Breast-Cancer-Related Lymphedema: Do We Follow the Evidence? A Two-Year Prospective Multicenter Cohort Study

SIMPLE SUMMARY: The early detection of breast-cancer-related lymphedema and referral for therapy can reduce lymphedema-related problems. We aimed to determine whether the early detection of lymphedema and referral for treatment is adequate. Women treated for breast cancer were followed up within a standard protocol for two years with several measurements, including arm volumes. A 5% or greater Relative Volume Change was used to diagnose for lymphedema and as an indication for therapy referral. Among the patients with early signs of lymphedema, 83% of them were not referred for therapy. This remained consistent over a 2-year follow-up period. Additionally, we noticed a significant improvement of the mean Relative Volume Change at 24 months within this group. We concluded that waiting with a therapy referral and carefully monitoring if symptoms change may represent an appropriate choice when lymphedema is detected within the first year post-surgery. ABSTRACT: The early detection of breast-cancer-related lymphedema and referral for therapy has the potential to reduce lymphedema-related morbidity. Although research shows the benefits, a gap is observed between evidence and daily practice. We aimed to determine whether the early detection of lymphedema and referral for treatment is adequate following the current guidelines. Women with primary breast cancer treated with breast-conserving therapy or ablative treatment were included. Demographic-, general health-, tumor-, and treatment-related data were recorded. Bilateral arm volume measurements were performed preoperatively and 3, 6, 12, and 24 months post-surgery. A 5% or greater Relative Volume Change was considered the cutoff point for lymphedema and as an indication for therapy referral. After 24 months post-surgery, the main outcomes show that among the patients with early signs of lymphedema, based on a Relative Volume Change ≥5%, a nonreferral for therapy was noted in 83%. Additionally, we observed a significant improvement of the mean Relative Volume Change at 24 months within this group, which might implicate that nonreferral was an adequate choice and that watchful waiting is appropriate when lymphedema is detected within the first year post-surgery.