Many of the precautionary guidelines related to lymphedema provided to breast cancer patients are anecdotal and not based on research. Unfortunately, many of these guidelines place a large burden on patients and clinicians who go to great lengths to abide by them. The avoidance behaviors can often be more impactful on quality of life than actually having lymphedema!

A recent study, published in March 2016, was the first large scale, prospective study to investigate whether there is an association between certain activities and increases in arm volume in patients treated for breast cancer and screened for lymphedema. These activities include blood draws, injections, blood pressure readings, trauma, cellulitis (infection) in the affected arm and air travel.

Subjects were 632 patients (760 at-risk arms) with newly diagnosed breast cancer. Bilateral arm volume measurements were performed preoperatively and postoperatively at 3 to 7 month intervals using a perometer. At each measurement, patients reported the number of blood draws, injections, blood pressure measurements, trauma to the at-risk arm(s), and number of air travel flights taken since their last measurement. Arm volume was quantified using the relative volume change and weight-adjusted change formulas.

In the total of 3,041 measurements carried out on the 632 subjects, there was no significant association between change in arm volume and undergoing one or more blood draws, injections, number of flights, or duration of flights. As has been previously found in other studies, factors significantly associated with increases in arm volume included weight gain (body mass index), axillary lymph node dissection and regional lymph node radiation and infection/cellulitis.

This study suggests that although cellulitis increases risk of lymphedema, blood draws, injections and blood pressure readings on the affected side, as well as air travel, may not be associated with arm volume increases.

The results of this study will provide clinicians and patients with much better evidence regarding risk factors and triggers of lymphedema. The clear risk factors for lymphedema are the number of lymph nodes removed, radiation to regional lymph nodes and higher BMI. Infection, or cellulitis, of the arm may be a trigger for lymphedema. Simple infection precautions make sense, such as using gloves when gardening and topical antibiotics for small cuts on the affected arm, Patients may prefer to continue to have blood draws and blood pressure taken on the unaffected arm, but should understand that these do not appear to trigger lymphedema based on this study. The issue of I.V.s was not addressed in this study and patients may want to continue to avoid these in the affected arm since, unlike a blood draw, fluid is being added to the limb. Flying does not appear to be a trigger to lymphedema; however, for women at moderate to high risk, TurningPoint physical therapists advise patients to travel with compression garments, in case swelling or lymphedema should become apparent while out of town.

Ferguson CM et al. Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer. J Clin Oncol. 34;7: 691-698.