Some doctors believe that the pressure changes the body goes through while flying on an airplane could trigger lymphedema in people who've had breast cancer surgery. The small study reviewed here found that only about 5% of women who had had breast cancer surgery developed persistent arm lymphedema after flying on an airplane. The results were presented at the 2008 San Antonio Breast Cancer Symposium.
Arm lymphedema is the swelling of the arm or hand because lymph fluid has accumulated there. A network of lymph channels and lymph nodes in the body, along with the normal flexing and contraction of muscles, helps move the fluid out of the body's soft tissues and back into the bloodstream. Breast cancer surgery can disrupt the lymph channels and lymph nodes and change the way the chest wall muscle works. These changes can cause lymphedema to develop on the side where the cancer was removed. Numbness, discomfort, and infection (sometimes) can happen along with the swelling. Lymphedema isn't life threatening, but it can be annoying and can last for a while.
Lymphedema is more likely to happen when the underarm (axillary) lymph nodes are removed during mastectomy or lumpectomy. The risk of lymphedema is also higher when:
About 5% to 10% of women treated for breast cancer develop lymphedema during or after treatment.
The 75 women who participated in this study were all training for dragon boat racing. All of them had surgery to remove early-stage breast cancer. In the 2 weeks before a long distance flight, the women had a special test -- called whole arm bioimpedance -- that measured the level of soft tissue fluid in the arm on the side where the breast cancer was removed. The same test was done 3 hours after the women landed and again 2 months after the flight.
The results:
Based on these results, the researchers concluded that flying on an airplane is unlike to cause or worsen lymphedema for most people who have had surgery to remove early-stage breast cancer. The researchers also pointed out that though some doctors tell people not to exercise and avoid heavy lifting to reduce the risk of lymphedema after breast cancer surgery, the women in this study were accomplished athletes (which involves exercise and lifting) and most were untroubled by lymphedema.
In the Breastcancer.org Arm Lymphedema section you can learn more about minimizing your own risk of lymphedema after surgery.
SAN ANTONIO, Dec. 12 (MedPage Today) -- Women who've had breast cancer surgery need not worry that pressure changes in an airplane cabin will bring on lymphedema, researchers found.
During a flight to Queensland, Australia, just 5% of women treated for breast cancer developed a clinically significant increase in intracellular fluid in their "at-risk" arm, Sharon Kilbreath, Ph.D., of the University of Sydney, and colleagues reported here at the San Antonio Breast Cancer Symposium.
In the prospective study, which enrolled 63 women traveling from Canada and 12 flying from other parts of Australia, mastectomy with full axillary node dissection and long-haul travel were associated with greater risk.
Dr. Kilbreath said the findings help dispel myths that have kept some breast cancer survivors grounded.
"The literature still warns women that if you get on an airplane you're either going to develop lymphedema or it will worsen," she said, noting that it was thought to result from extra demand on the lymphatic system from cabin pressure changes.
Her group prospectively studied 75 women traveling to Queensland, to compete in a dragon boat regatta in 2007. All had been treated surgically for breast cancer -- some many years previously -- which typically included axillary node dissection.
Each woman had whole arm impedance measured using single frequency bioimpedance analysis within two weeks before departure and within three hours after exiting the plane. About half were also tested two months after they returned home.
Extracellular fluid fluctuated somewhat but without a significant effect on impedance ratio either overall or for the 63 women traveling long distance from Canada (both P>0.05).
The impedance ratio increased by 2% or less in 48 women and 2% to 5% in another 12.
Of the 15 women with a clinically significant increase of 5% or more, 14 had made long-haul flights from Canada of about 14 hours duration and 12 had had prior mastectomy with complete axillary node dissection.
Just two of the cases were new onset lymphedema; three had lymphedema prior to the flight.
Only eight women -- all who flew from Canada -- exceeded the impedance ratio cut-off for lymphedema diagnosis.
At the two-month follow-up, four of the seven measured dropped back below the cut-off.
Dr. Kilbreath noted that some of the women actually had a decrease in extracellular fluid measurements after their flights, possibly because of dehydration.
"We know that even healthy women have some fluctuation," she said.
She noted that study participants ranged in body mass index up to over 30 kg/m2, which suggested the findings would be generalizable.
Her group is now starting to investigate the isolated effects of simulated cabin pressure changes without other aspects of travel.
Because all the women had been in training for the dragon boat race, Dr. Kilbreath said the findings were encouraging substantiation against another common belief.
"Women had also been told not to exercise, not lift heavy things, and take good care of their arm," she said, but accumulating evidence now suggests that exercise may actually be protective.
The study was supported by ImpediMed, maker of the impedance measuring device. Dr. Kilbreath reported no conflicts of interest.
Primary source: San Antonio Breast Cancer Symposium Source reference: Kilbreath S, et al "Effect of airplane travel on women treated for breast cancer" SABCS 2008; Abstract 1191.
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