Lymphoedema and risk

Date: 17 Mar 2010
Who is at risk?
It is estimated that 25 – 35% of patients who have surgery and/or radiotherapy to the armpit as part of their treatment for breast cancer go on to develop lymphoedema at some time in their life.
This figure will be less for people who have sentinel lymph node biopsy of the armpit, as this is less traumatic to the lymph system. It is not yet known why some people develop this condition and others don’t.
The vast majority of people who develop lymphoedema after breast cancer and its treatment have only mild to moderate symptoms. It is only the arm, hand and fingers on the same side as the affected breast that become ‘at risk’.
How can I reduce my risk of developing lymphoedema?
While it is not known exactly what causes lymphoedema, an infection or injury to your ‘at risk’ arm may slightly increase your chances of developing it. The following advice may help to protect your arm and hand and so reduce your risk.
• Try to use your arm normally. Gentle, non-repetitive exercise, such as walking or swimming, will keep your joints supple and is important for lymph drainage.
• Look after the skin on your ‘at risk’ arm. Wash it every day and avoid soaps that dry out the skin. You should also avoid using very hot or cold water. Dry your arm and hand thoroughly and use a moisturising cream, such as aqueous cream, to help keep the skin supple and moist.
• If possible, avoid having your blood pressure or blood samples taken from your ‘at risk’ arm. Also avoid having acupuncture and injections into the arm. If both your arms are affected then your blood pressure or blood samples may be taken from your legs or feet.
• Try to avoid cuts, scratches, insect bites or stings on your ’at risk’ arm. Wear protective gloves when gardening or washing up, and a thimble when sewing. Use insect repellent when appropriate. If your skin is damaged, treat promptly, cleaning and applying antiseptic.
• Avoid biting your nails. Use a nail file and take care to avoid damage to the cuticles when cutting your nails, as this can allow bacteria to enter and cause infection.
• Avoid getting sunburnt. Use a sunscreen with a high sun protection factor (SPF), 15 or above, and remember to apply it even under clothing as it is possible to become sunburnt through certain clothing.
• Take care when removing unwanted hair in your armpit. Using a well-maintained electric razor is safest. Waxing is not recommended because it can cause damage to the skin and might increase the risk of infection. Depilatory (hair removal) creams may be used with caution and it is advisable to do a patch test first to check for skin reactions. Remember that the area may be numb, meaning you will not feel any soreness or reaction as it develops, so take care when applying the cream and always follow the instructions.
• Avoid constriction around the arm and armpit from tight fitting bras, sleeves and clothing or heavy shoulder bags. Also ensure watches, rings and bracelets are not too tight.
• Try not to strain with activities such as pushing or pulling, digging the garden or heavy lifting such as carrying heavy shopping bags.
• During long flights, train journeys, car or bus trips, try to gently exercise your arm as much as possible. If you are standing on a train or a bus, try not to use your ‘at risk’ arm to hold on.
• You may wish to discuss with your doctor the possibility of using a properly-fitted compression sleeve if you are going to be flying.
• Try to maintain a healthy body weight by taking regular exercise and following a balanced diet.
What should I do if I notice swelling?
If you notice any swelling of your arm, hand, fingers, breast or chest wall, tell your breast care nurse or hospital specialist as soon as possible. It is also important to tell them if you notice any pain, discomfort or reddening of the skin. They can examine you to confirm if the symptom is lymphoedema-related. If it is, you should then be referred to a lymphoedema specialist. If you do develop lymphoedema, its symptoms respond well to treatment and can be controlled and improved in most cases.