Acupuncture and breast cancer-related lymphedema: Quackademia strikes again

Lymphedema is a complication of breast cancer surgery that all surgeons who do breast surgery detest. Patients, of course, detest it even more. The limb swelling that is the primary symptom of lymphedema comes about because surgery on the axillary lymph nodes (the lymph nodes under the arm) that is part and parcel of surgery for breast cancer can interrupt lymph vessels and cause backup of lymph fluid in the affected arm. This backup has consequences, including skin changes, a tendency towards infections, and, in extreme cases, elephantiasis (which is, fortunately, rarely seen these days as a result of breast cancer surgery). Unfortunately, lymphedema is incurable, and the risk of developing it never goes away after breast surgery.

Lymphedema used to be much more of a problem back in the old days (say, more than 10-15 years ago), when surgery for breast cancer routinely involved an axillary dissection, or removal of most of the lymph nodes under the arm. (For surgery geeks, in breast surgery level 1 and 2 lymph nodes out of three levels, unless, of course, leven 3 nodes are grossly involved with tumor, in which case they’re taken too.) Frequently radiation therapy was needed as well, and the combination of axillary dissection and radiation therapy could produce a risk of lymphedema as high as 50%. Of course, in recent years, sentinel lymph node biopsy, which involves removing many fewer nodes (usually 1-3) has supplanted axillary dissection for most cases of breast cancer, and, consistent with fewer nodes being taken, the risk of lymphedema from sentinel lymph node biopsy is much lower. However, none of this means that lymphedema isn’t still a problem after breast surgery; it’s just less of a problem.

There are only a few basic strategies for treating lymphedema, sometimes called decongestive lymphatic therapy. For the most part, these treatments involve physical therapy, compression sleeves to “squeeze” the fluid out of the affected limb, and sometimes the use of mechanical compression stockings that “milk” the fluid back. It’s all very inconvenient and unpleasant, and there’s no doubt that this particular complication can take a major toll on a patient’s quality of life and sometimes even lead to hospitalizations for infection. It might be less of a problem than it was in years past, thanks to less invasive surgery, but it’s still a problem, and it needs better treatments.

Acupuncture is not one of them.