June Newsletter: Safe Summer Fun for Survivors

Kari Cataldo, M.D., Retired Family Physician; Breast Cancer Recovery Alumna, Volunteer, and Board Member.

It doesn’t get better than this! We cherish the beautiful summer days in the Midwest, spending time on a lake, a trail or in the garden. However, as breast cancer survivors who face a risk of lymphedema, we may be wondering if there is a way to enjoy it all safely?

Lymphedema is the buildup of lymph fluid in the fatty tissues just under your skin that causes swelling of a localized part of the body. The lymph fluid normally flows through the lymph vessels and into lymph nodes which filter the fluid, and it relies partly on muscle movement to pump the fluid back into large veins in the chest. For breast cancer survivors, surgical removal of lymph nodes, damage from radiation, and obstruction of lymph vessels due to scar tissue can block the flow of lymph fluid, sometimes leading to lymphedema.

Breast cancer survivors have varying risks of developing lymphedema, depending on their treatment history. According to research, the overall incidence of breast cancer-related lymphedema is 21.4%. Although the risk persists for the rest of our lives, most cases of lymphedema occur within three years of breast surgery. Axillary lymph node dissection carries the greatest risk of lymphedema at 19.9%, while sentinel node biopsy risk is 5.6%. Additional risk factors for developing lymphedema include regional lymph node radiation, infection of the affected limb, and obesity (BMI 30 or greater) (1).

So how can we minimize the risk of lymphedema but still enjoy summer? The good news is that by getting outside and moving, we can reduce our risk! Exercise increases heart rate, respiratory rate, and contracts muscles to help pump the lymph fluid. Engaging in activities like kayaking, walking, gardening, swimming/water aerobics, and pickle ball can lower risk and may help you maintain or even lose weight.

Stretching after exercise and activities such as yoga are also great for preventing lymphedema, as this can stretch out muscles, skin, and scar tissue. The U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2) recommends that all adults:

• Get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.
• Add moderate to high intensity muscle strengthening activity (such as resistance or weight lifting) on at least 2 days per week.
• Check with your physician before starting any new exercise.

The other main way to reduce risk of lymphedema is to protect your skin from infection. This is especially true in the summer, as we are often outside and exposed to more infection risks. Any inflammation by injury or infection causes more blood flow and lymph fluid to go to that area. It may overwhelm the lymphatic system, leading to lymphedema. You can reduce this risk by following a few simple rules:

• Always wear gloves when gardening or doing yard work.
• Wear long sleeves and insect repellent to protect against scratches, insect bites/stings, poison ivy, as well as protecting from sunburn. Unless you have a diagnosis of lymphedema, do not wear compression sleeves or tight elastic sleeves. Also avoid wearing tight jewelry.
• If your skin has been exposed to poison ivy or poison oak, wash the area gently with soapy water or rubbing alcohol, then rinse as soon as possible.
• If you get an injury that breaks the skin, clean it thoroughly with running water and cover with antibacterial ointment and a bandage. Change the bandage daily and watch for signs of infection.
• Seek medical attention promptly if you have signs of infection such as expanding redness, worsening pain, drainage, warmth or swelling.

The good news is that treatment is very effective in the early stages of lymphedema. Signs and symptoms of lymphedema include swelling, tightness, heaviness, fullness, pain, or impaired function of the affected arm, hand, shoulder, breast, and/or chest. If you think you may be developing lymphedema, contact your oncologist or primary care physician and seek out a certified lymphedema therapist in your area.

Now that we know how to stay safeguarded from lymphedema, let’s get outside and enjoy the summer!

1. Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland Surg. 2018 Aug;7(4):379-403. doi: 10.21037/gs.2017.11.04. PMID: 30175055; PMCID: PMC6107585.

2. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.