Other factors will also have contributed to the BCRL outcome,
including provision of lymphoedema treatment;
the majority of those who had experienced BCRL had
received some form of lymphoedema treatment.
The combination of patient report, clinical assessment
and objective measurement to determine prevalence
provides a strong level of confidence in the findings. We
achieved a reasonable response rate to the questionnaire
(60 %) and a high conversion rate (87 %) to the assessment
phase; however, we do not know what happened
to the 31 women (40 %) who did not return a completed
questionnaire, nor were we able to confirm the selfreport
of the six women who completed questionnaires
(part 1) but did not attend the assessment (part 2). The
study population included women whose attendance
at the class had been recommended by the local breast
cancer service, and also women who had actively sought
out the lymphoedema awareness class following breast
cancer treatment elsewhere in London and the UK; we
did not collect information about the hospital where the
women received their cancer treatment.
Our findings have led us to conclude that clinicianjudgement
should be combined with objective measurement
of ELV to avoid underestimation of BCRL, and to
detect mild arm lymphoedema and also lymphoedema
limited to the hand; in addition, patient self-report should
be taken into consideration. Further research should be
conducted to determine the protective and treatment
benefits of providing group education from a lymphoedema
expert and of teaching specific exercise; this is in
addition to providing written information regarding lymphoedema
care and general exercise.