Prevention
The literature on prevention of lymphedema focuses primarily
on specific surgical techniques to reduce damage to the axillary
lymphatic system. No randomized controlled trials or cohort
studies were identified that addressed interventions
designed specifically to prevent lymphedema after treatment
with surgery or radiation therapy. Although a number of recommendations
for preventing lymphedema can be found in review
articles and in the nursing literature, no evidence base exists that
demonstrates the efficacy of one mode of prevention over another
or even the efficacy of preventive measures versus no
preventive measures.
One important category of prevention relates to the known
association between axillary node dissection and the incidence
of arm edema. The introduction of the sentinel node biopsy as a
way to identify women who truly need axillary node dissection
may translate into a smaller number of women undergoing axillary
node dissection (66). However, a substantial number of
women will still have to undergo axillary node dissection. Some
of these women will also undergo radiation therapy and so be at
high risk for arm edema (3,67). Thus, other strategies to prevent
or minimize arm edema must be developed.
Four categories of prevention interventions are repeatedly
mentioned across the breast cancer literature: 1) avoidance of
trauma/injury, 2) prevention of infection, 3) avoidance of arm
constriction, and 4) use and exercise of the limb. Strategies for
implementing these measures include using protective gloves for
household work and gardening (68–72); avoiding venipuncture,