Infection and skin trauma incrementally increase the risk of breast cancerrelated lymphedema
By Dr. Mei Rosemary Fu
Conventionally, breast cancer survivors are instructed to avoid certain daily-living activities or incidents to reduce the risk of breast cancerrelated lymphedema (BCLE).1-2 These activities or incidents include using the affected arm and hand to lift objects, carrying shoulder bags, and avoiding infection, sunburn, cutting cuticles, oil splashes and steam burn.1-2
A recent published study3-5 in Annals of Surgical Oncology provided much-needed evidence regarding the daily-living risks of lymphedema and offers insights into targeted strategies to reduce the risk of lymphedema. This article is available online (https://doi.org/10.1245/s10434-02415946-x) or as a PDF https://link.springer.com/content/pdf/10.1245/ s10434-024-15946-x.pdf. (See synopsis of the study on the right).
This larger cross-sectional and observational study of 567 breast cancer survivors examined the effects of daily-living risks on BCLE. As presented in the published Visual Abstract,5 significant odds of BCLE were associated with infection (OR = 2.58, 95% CI = 1.95-3.42), cuts/scratches (OR = 2.65, 95% CI = 1.97-3.56), sunburn (OR = 1.89, 95% CI = 1.39-3.56), oil splash or steam burns (OR = 2.08, 95% CI = 1.53-3.83), insect bites (OR = 1.59, 95% CI = 1.18-2.13). The daily-living risks were clustered into factors related to skin trauma and carrying objects. Skin trauma risk was significantly associated with BCLE (B = 0.539, z = 3.926, OR = 1.714, 95% CI = 1.312-2.250, p < 0.001). Having 3, 4, or 5 skin trauma risks significantly increased the odds of BCLE to 4.31, 5.14, and 6.94 times. No significant associations between daily-living risks of carrying or lifting heavy objects, carrying groceries, and lifting weights. Carrying a shoulder bag on the affected arm was significantly associated with BCLE, with odds of 0.55, indicating that carrying a shoulder bag may have a protective effect on BCLE.
As complete avoidance of daily-living risks is challenging,3 it is critical for patients to be trained for self-care skills for daily skin care, preventing and managing skin trauma (Box 1).3 More prospective and longitudinal research is vital to further validate daily-living risks for BCLE. LP
References
The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema (BCLE)
Strategies to Minimize Daily-Living Risks of Breast Cancer-Related Lymphedema18, 22-25
What should I do to prevent trauma/injuries in my affected hand and arm?
4 Wear protective gloves while gardening or doing household chores (washing dishes, cleaning, or cooking).
4 Wear oven mitts when taking hot pots or casseroles out of the oven.
4 Apply sunscreen (SPF 30 or more) or wear long-sleeve clothes to prevent sunburn.
4 Apply insect repellant or wear an insect-repellant band to prevent insect bites.
4 Cuticles should be pushed back and kept moist; Manicure tools should be sterilized
What should I do for daily skin care?
4 Keep skin clean and dry.
4 Use water-based lotions that help skin to absorb readily and low-pH lotions that provide an active barrier against infection.
What should I do when I have cuts or scratches on my affected arm or hand?
4 Wash the area with soap and water.
4 Apply an antibiotic cream or ointment.
4 Cover with a clean and dry dressing as needed.
4 If the area becomes worse, call your doctor.
What should I do when I have mosquito or insect bites?
4 For itching, apply hydrocortisone ointment.
4 If the area is red and slightly inflamed, apply an antibiotic ointment.
4 If the area becomes worse, call your doctor.
What should I do if I notice any changes in my affected arm or hand?
4 Do not ignore any changes in your affected arm or hand.
4 If you notice a rash, blisters, redness, increased warmth/heat in the arm and/or pain, please contact your doctor right away.
1. Shen A, Lu Q, Fu X, et al. Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer. 2022;31(1):18. Published 2022 Dec 14. doi:10.1007/s00520-022-07508-2
2. Cemal Y, Pusic A, Mehrara BJ. Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. Oct 2011; 213(4):543-51.
3. Fu MR, Liu B, Qiu JM, et al. The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema. Ann Surg Oncol. 2024;31(12):8076-8085. doi:10.1245/s10434-024-15946-x.
4. Fu MR, Liu B, Qiu JM, et al. ASO Author Reflections: Infection and Skin Trauma Incrementally Increase the Risk of Breast Cancer-Related Lymphedema. Ann Surg Oncol. 2024;31(12):8110-8111. doi:10.1245/s10434-024-16078-y
5. Fu, M.R., Liu, B., Qiu, J.M. Sun, Y., Axelrod, D., Guth, A., Korth, S., Kremer, H.L., Wang, Y. (2024). ASO Visual Abstract: The Effects of Daily-Living Risks on Breast CancerRelated Lymphedema. Ann Surg Oncol (2024).
Dr. Mei Rosemary Fu, PhD, RN, FAAN, is The Dorothy and Dale Thompson Missouri Endowed Professor in Nursing and Associate Dean for Research at University of Missouri-Kansas City School of Nursing and Health Studies. Email: mei.fu@umkc.edu or mf67@nyu.edu
Disclosures: No conflicts of interest.