Link Between the Lymphatic System and Breast Cancer
Abstract
The lymphatic system has not been adequately emphasized in me...
lymphedema and as an adjunct for preventing cancer, like improvements in diet and
exercise. MLD is a powerful tool that is...
The book Dressed To Kill1
addresses bra wearing and its connection to cancer, written
from an anthropological viewpoint. F...
The lymphatic system is separate from the blood circulatory system whose function is to
carry fluid from the body tissues ...
approximately 90% of this fluid7
. Some of the residual intercellular (or interstitial fluid)
is collected through the ini...
Lymphedema
Just as venous blood pooling may cause varicose veins, lymphatic fluid stasis may cause
lymphedema. Skin and un...
proteins in stagnant interstitial fluid as foreign particles. This leads to an inflammatory
response with pain, redness, a...
The third model is by the National Cancer Institute. It is their latest version (Common
Toxicity Criteria v 3.0). It invol...
The post-operative measurements should be taken at every subsequent visit and the data
compared with the 1st
measurements....
structures next to the initial lymphatics. These have valves at their entrances and exits.
They respond to increased press...
carried on and eventually to be delivered to the subclavian veins. 22
Toxin concentration
could occur, especially closer t...
lung cancer coupled with treatment effectiveness.) The lungs interestingly have more
incidences of cancer in the right tha...
(such as the breasts) exist elsewhere on the body, these would be less likely to have
lymphatic fluid filtering them than ...
the one of the largest and most used muscle group in the body—the gluteals. The
abdominals by contrast do not get nearly t...
One could determine from study that any massage will likely help lymphatic flow but
especially as it directs the fluid tow...
Many other questions could be proposed related to the lymphatic system and cancer.
Does an excess of dietary protein overl...
wearing constrictive clothing around the breast region (bras) because this could constrict
lymphatic flow. The two groups ...
Link Between the Lymphatic System and Breast
Cancer
(a literature review and hypothesis)
By
Kathleen McLaughlin PT
4/25/08
847-370-5738
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Link-Between-the-Lymphatic-System-and-Breast-Cancer.doc

  1. 1. Link Between the Lymphatic System and Breast Cancer Abstract The lymphatic system has not been adequately emphasized in medical study and practice. As a result of research on this subject, one might conclude that the surface has just been scratched in understanding this system. This is even more emphatically so with the lymphatic system and its link to breast cancer. A consequence of breast cancer treatment for many women is lymphedema. The base of knowledge in this area is also in its infancy. Tests for this dysfunction are underutilized and should be expanded to preoperative and postoperative arm systems that are standardized and more accurate. Early detection will facilitate intervention, which should include instruction in manual lymphatic drainage (MLD) and in avoidance of constrictive clothing. Promotion of lymphatic flow through MLD could also prove to be a significant contributor in preventing and fighting breast cancer. Given the prevalence of breast cancer, a study of the effects of MLD upon cancer occurrence rates in patients seems warranted. This seems especially true for women at higher risk for cancer, genetically or because of benign breast disease (with or without atypical hyperplasia). There is ample evidence that MLD has been helpful in the treatment of severe lymphedema. MLD now needs to be investigated for prophylactic use—to prevent
  2. 2. lymphedema and as an adjunct for preventing cancer, like improvements in diet and exercise. MLD is a powerful tool that is being underutilized. Purpose and Primary Hypothesis The purpose of this paper is twofold: to propose a specific clinical study. The study would be based on the following hypothesis: breast cancer may be linked to inadequacies in lymphatic function, and treatment should include MLD to aid this system. An additional goal is to propose studies of preventative measures using MLD. Potentially, women could implement these massage techniques as prophylaxis for breast cancer. Public education in lymphatic care could be promoted in a way similar to teeth flossing for dental health. Breast cancer is a complicated disease without one clear etiology, and lymphatic dysfunction may be one of many causative factors. Training in MLD and non- constrictive clothing use could be just one more tool in the arsenal of weapons for fighting cancer. Current Theory This investigation was started on the basis of this assumption: the lymphatic system is key to the prevention and healing of breast cancer. This seems elementary, but there is a minimum of information linking lymphatic function to breast cancer prevention or treatment. A preponderance of information exists about the lymphatic system as a conduit for metastasis.
  3. 3. The book Dressed To Kill1 addresses bra wearing and its connection to cancer, written from an anthropological viewpoint. From their data, there does seem to be a correlation between constriction and breast cancer. Intuitively, one would think this is because of restricted flow of the lymphatics. Kett et al link the status of axillary lymph drainage with the chance of survival for breast cancer patients.2 The study by Witte et al gives a review of current theory in relation to the lymphatic system and cancer. Furthermore, it points out the need for more knowledge of this crucial body system. As with its role in preventing infection, the lymphatic system is likely crucial in preventing toxin (or carcinogen) buildup, in fighting non- entrenched cancer cells, and in fighting established cancer, especially as related to the breasts. The importance of the lymphatic system is emerging in understanding all pathophysiology. Anatomy and Physiology of the Lymphatic System 1 Sydney Ross Singer and Soma Grismaijer. Dressed to Kill, The Link Between Breast Cancer and Bras. (New York: Avery Publishing Group, 1995) xv. 2 K. Kett, K. Szilagyi, B. Anga, A.Kett, K. Kiralyfalvi. “Axillary Lymph Drainage as a Prognostic Factor of Survival in Breast Cancer.” Lymphology. Dec. 2002; 35(4): 161- 170.
  4. 4. The lymphatic system is separate from the blood circulatory system whose function is to carry fluid from the body tissues back toward the heart. It also filters out toxins and manufactures lymphocytes to fight infections. Another function is the transport of excess proteins.3 It balances fluid and distributes immune cells where they are needed throughout the body. The lymphatics also carry digested fat from the intestines to the blood vessels. They additionally help in the repair of damaged tissues.4 The lymphatic system consists of: 1) initial lymphatics (or lymph capillaries), 2) pre- collecting vessels or pre-collectors, 3) lymph vessels (collectors and trunks), 4) lymph nodes, 5) aggregated lymph nodules, 6) lymph tissue, and lymphocytes and 7) lymphatic fluid. The tonsils, thymus, and spleen are also made of lymph tissue. Lymphatics do not exist in the brain, spinal cord, eyes, bone marrow, tissues without blood vessels like cartilage, or voluntary muscles.5 Lymphatic fluid does, however, move through skeletal or voluntary muscles. These muscles are essentially scrubbed clean during exercise, which increases lymph circulation up to 15 times that of resting. This cleanses the muscles as well as the area around them of protein, dead cells, and waste products.6 Reviewing basic lymphatic system physiology, we learn that fluid, along with some other substances, leaks into the body tissues through the walls of the smallest blood vessels called capillaries. This occurs because of pressure differences between the capillaries and the tissue. The venous capillaries carrying blood back to the heart reabsorb 3 French. 26. 4 French. 26. 5 French. 5. 6 French. 22.
  5. 5. approximately 90% of this fluid7 . Some of the residual intercellular (or interstitial fluid) is collected through the initial lymphatics, the smallest tubules in this system. These drain into progressively larger lymphatic tubules (pre-collectors), which eventually empty into the bigger lymph vessels (collectors then trunks), which go to either the right lymphatic duct or the thoracic duct, rarely called the left lymphatic duct. These ducts connect to large veins at the base of the neck. The thoracic duct empties into the left venous angle connecting to the subclavian or jugular vein, and the right lymphatic duct empties into the right subclavian vein.8 As this fluid makes its journey, it is filtered periodically by lymph nodes. These are the small round lumps that one can feel in the neck, underarm, or groin regions when there is an infection. There are approximately 6009 to 70010 lymph nodes in the body. In these nodes the production of some of the body’s lymphocytes occurs. These nodes as well as the lymphatic vessels have one-way valves to stop backflow of the fluid.11 The movement of the lymphatic fluid into the initial lymphatics then into the pre- collectors is aided by the contractions of the voluntary or skeletal muscles, like the triceps, biceps or pectoral muscles. In these two aspects (the one way valves and the aid of fluid flow by muscle contraction) the lymphatic vessels are similar to the veins. Additionally, pooling of the lymphatic and the venous fluid can occur. 7 French. 7-10. 8 French. 11. 9 Jane Board, Wendy Harlow. “Lymphoedema 1: Components and Function of the Lymphatic System.” British Journal of Nursing. Jan. 2002, 10 Jane Lacovara, Linda Yoder. “Secondary Lymphedema in the Cancer Patient.” MedSurg Nursing. Oct 2006; 15(i5): 307. 11 French. 10-14.
  6. 6. Lymphedema Just as venous blood pooling may cause varicose veins, lymphatic fluid stasis may cause lymphedema. Skin and underlying tissues that stay indented when pressed indicate edema is present. This means fluid has accumulated in the tissues instead of being carried back to the heart. Another method of detecting edema is to measure the non-involved extremity with a tape measure and compare it with the involved side.12 Edema can be temporary, as from a strain, too much dietary salt, or other issues. Lymphedema presents in the same way, however it is caused by dysfunction in the lymphatic system. It may be caused by a congenital malformation, which is classified as primary lymphedema. Secondary lymphedema arises from damage by surgery, radiation, infection, or injury to the lymphatic system. The literature reports that women who have had breast cancer treatment have an occurrence rate of lymphedema in a range between 25%13 to 30%14 (for women with any kind of axillary intervention) and 49%(for those with complete axillary dissections.)15 Breast cancer treatments, including radiation and axillary surgery, are recognized as the most common cause of secondary lymphedema. Lymphedema may have grave consequences. When the fluid is not removed from the tissues promptly, it is like a stagnant pond. Bacteria can multiply and eventually lead to cellulitis, which is very serious and difficult to heal. The body responds to excess 12 J. Armer. “The Problem of Post-Breast Cancer Lymphedema: Impact and Measurement Issues.” Cancer Invest. 2005; 23(1): 76-83 13 E. Jeffs. Treating Breast Cancer-Related Lymphoedema at the London Haven: Clinical Audit Results.” Eur. J. Oncol. Nurs. Feb 2006; 10(1):71-9. Epub Jun. 3, 2005. 14 Nina Linnitt. “Lymphoedema: Recognition, Assessment and Management.” 15 J. A. Petrek, R. T. Senie, M. Peters, P. Rosen. “Lymphedema in a Cohort of Breast Carcinoma Survivors 20 Years After Diagnosis.” Cancer. Sep, 2001; 92(6): 1368-77.
  7. 7. proteins in stagnant interstitial fluid as foreign particles. This leads to an inflammatory response with pain, redness, and heat. There can be scarring, damage to the blood vessels, tissues, and skin. This can become a vicious cycle and in extreme cases can become reflex sympathetic dystrophy or elephantiasis.16 Lymphedema may be under- reported because the current medical model seems to look only for extreme lymphedema. There must be early stages that are being missed. There are currently three models in use for detecting lymphedema.17 The first is the American Physical Therapy Association model. This is a 3-point scale (grading mild, moderate, or severe) based completely on comparisons of the circumference between the ipsilateral and contralateral sides. There are no standard anatomical measuring points designated. One problem with this system is that the dominant and non-dominant arms differ in circumference normally. Another problem is that a 2-centimeter difference might be large for a very thin woman and minimal for an obese woman. The International Society of Lymphology scale has 2 criteria of basis. These are: the “softness” or “firmness” of the extremity, as well as the outcome of 24 hours of elevation. Grade 1 lymphedema (apart from the firmness judgment) resolves completely with 24-hour elevation. Grade 2 would show a partial resolution. Grade 3 would have no change. 16 French. 3. 17 J Perek. “Commentary: Prospective Trial of Complete Decongestive Therapy for Upper Extremity Lymphedema After Breast Cancer Therapy.” New York, New York. From the Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Dec 12, 2003; 17-18.
  8. 8. The third model is by the National Cancer Institute. It is their latest version (Common Toxicity Criteria v 3.0). It involves three criteria for judging. The first is the percent difference between limb circumferences at its visually largest point on the involved limb as compared with the other arm. The other bases for judgment are soft tissue change and dermal change. A problem that with all three models is that they are for those with well-developed lymphedema. They don’t help with early detection (so that early treatment can ensue). A definitive tool for detecting lymphedema is lymphoscintigraphy. This is expensive and may not be readily available. Dye injection can also be very painful. Here is an alternative model. Pre-surgical circumferences should be routinely taken in both upper extremities for any patient who will have axillary intervention. These should be standardized to these anatomical points: mid upper arm (15 centimeters proximal to the elbow), elbow in the arm-straight position, mid lower arm (15 cm. proximal to the wrist), around the wrist, and around the base of the metacarpals. Another possible inexpensive and quick way to measure would be to monitor changes in tissue conductivity. This would have to be standardized, but may have great potential.
  9. 9. The post-operative measurements should be taken at every subsequent visit and the data compared with the 1st measurements. An increase may mean early lymphedema, especially if it is coupled with pain and soft tissue or dermal changes. Early treatment is almost always more effective for lymphedema18 as well as for most problems. Lymphatic Flow—Extrinsic and Intrinsic Pumps Many factors help to move the lymphatic fluid. Movements, even as small as blinking or stretching pull the attachments of the lymphatic capillaries by the tiny filaments to the surrounding tissues. This stretches the epithelial flaps apart and lets the interstitial fluid enter. Breathing, abdominal peristalsis, and the heartbeat are all thought to have an effect through pressure changes. Skeletal muscle contractions are also a factor in making fluid enter the initial lymphatics. Another method that can increase fluid intake is massage or passive motion.19 Technically none of these things are a pump, but they serve as a sort of extrinsic pump especially in getting the lymphatic capillaries to fill with interstitial fluid. There is no smooth muscle in the walls of the initial lymphatics or pre-collectors. The larger lymphatics seem to have an intrinsic lymphatic pump powered by the smooth muscle in walls of these larger lymph vessels. The muscle layer varies from one cell thick to a complex, multilayered structure in the bigger vessels. Lymphangions are 18 Lacovara. 307. 19 W Olszewski. “Contractility Patterns of Normal and Pathologically Changed Human Lymphatics.” Ann N Y Acad Sci. Dec 2002. 979: 52-63.
  10. 10. structures next to the initial lymphatics. These have valves at their entrances and exits. They respond to increased pressure of the lymphatic fluid inside the vessels and contract in a manner similar to peristalsis in the intestines.20 Right Side Versus Left Side Lymphatics The anatomy of the lymphatic system varies greatly on each side of the body. The right side empties only the right side of the thorax, arm and head (except the brain and voluntary muscles etc.). The left lymphatics drain the right leg, and the whole left side of the body (with the exceptions listed earlier).21 Hypothetical Outcomes Could the anatomical difference mentioned above cause more lymphatic backup on the left side? Could the pressure gradation due to differing anatomy cause a variance in efficiency of lymphatic flow on each side? These are possibilities, but I have not been able to find anything about the effects of this anatomical difference in the literature. Possibly, the outcome from the left side lymphatics draining a significantly greater portion of the body (or having a different internal pressure from the right) could be lymphatic fluid stasis. This in turn could lead to toxin build- up in the inadequately drained tissues. Lymph vessels allow osmosis, letting fluid flow in and out of the vessels. As the water filters out of the vessels, the lymphatic fluid becomes more concentrated with particles and toxins as it progresses toward the neck. This is because water filters out of the vessels and nodes leaving more large molecules like proteins and cells to be 20 French. 21. 21 French 12.
  11. 11. carried on and eventually to be delivered to the subclavian veins. 22 Toxin concentration could occur, especially closer to the left (thoracic) and right lymphatic ducts as a result of this process (because that is the end of the lymphatic journey). This means the highest concentration would be closest, in theory, to the breasts and the lungs. Some of these toxins could be carcinogens and some cancers may result from their presence in the breast tissues. It seems reasonable that toxin accumulation would occur to the greatest extent in the parts of the body with the least efficient lymphatic drainage. This actually is a sub-hypothesis, which could be studied for definitive answers. According to my hypothetical model, the least efficient region would be the left side especially in areas not close to skeletal muscle. The breasts do not have skeletal muscles inside the breast tissue. They are superficial to the pectoral muscles. Thus, the most susceptible area should be the left breast. Laterality This bears out in research. Breast cancer is the most frequently diagnosed cancer in United States women, second only to skin cancer.23 The left breast has a higher cancer occurrence rate than the right24 and breast cancer is second only to lung cancer in cancer mortality rates in women.25 (This may be because of the difficulty of early detection of 22 French 7. 23 CNN Interview with Dr. Sanjay Gupta. Posted: 932 a.m. EDT, Oct. 6, 2006. http://www.cnn.com/2005/HEALTH/10/10/breast cancer. QA/index.html. 24 R. Roychoudhuri, V. Putcha, and H. Moller. “Cancer and Laterality: A Study of the Five Major Paired Organs (UK).” Cancer Causes Control. Jun 2006; 17(5): 655-62. 25 No author cited. “Lung Cancer.” BBC News. Jan 30, 2004 update. http://news.bbc.co.uk/2/hi/health/medical_notes/3243673.stm.
  12. 12. lung cancer coupled with treatment effectiveness.) The lungs interestingly have more incidences of cancer in the right than the left lung, but this is thought to be because the right lung has so much more mass.26 This fits the hypothesis that the most overloaded regions of lymphatic drainage are most prone to developing cancer. Hypothetically, lymphatic fluid pooling results in toxin accumulation as well as the other consequences listed previously. Presumably, the toxin accumulation is caused by lack of lymphatic fluid movement through the tissue. The filtering action of the lymphatic system would be less efficient there, with resultant toxin concentration. Again, this is a sub-hypothesis, which could be corroborated by further research. Exercise Other studies seem to further corroborate this line of thinking. Numerous studies have linked exercise inversely with cancer. One systematic review stated that a trend analysis showed a 6% decrease in breast cancer risk for every hour on a weekly basis of sustained physical activity.27 This makes sense in light of the fact that muscle pumping propels the lymphatic fluid, thus making the lymphatic drainage more complete with less toxin accumulation. Obesity Furthermore, obesity is correlated with higher risk for many cancers.28 If pillows of fat 26 R. Roychoudhuri. 655-62. 27 E. M Monninkhof, S. G. Elias, F. A. Viems, I. van der Tweel, A. J. Schuit, D. W. Voskull, F. E. van Leeuwen. TFPAC. “Physical Activity and Breast Cancer: A Systematic Review.” Epidemiology. Jan. 2007; 18(1): 137-57. 28 A. McTiernan. “Behavioral Risks in Breast Cancer: Can Risk Be Modified?” Oncologist. 2003; 8(4): 326-34
  13. 13. (such as the breasts) exist elsewhere on the body, these would be less likely to have lymphatic fluid filtering them than the rest of the body because of lack of muscle in these cushions. Hence they would become repositories of toxins. Why does breast tissue develop cancer whereas abdominal fat does not seem to? It is usually the mammary glands, the ducts and lobes of the lactation system, which develop cancer not the fat tissue.29 The fat or adipose tissue can be involved, but it is more rare.30 This possibly explains why the breasts have higher cancer occurrence rates from the omentum and other fatty areas. Breast size has not been consistently correlated with breast cancer.31 This would seem to negate my hypothesis. However, this may be complicated by other factors, such as breast density, which has been linked with an increase in cancer occurrence.32 Patterns of Fat Deposits Another possible correlation is the finding that a pear shaped woman, with fat deposits on her hips and upper legs, is less likely to get breast cancer than one with fat deposits around her waist.33 This could be explained by the fact that hip adipose tissue is close to 29 J. C Kneece. Breast Cancer Treatment Handbook. West Columbia, SC: EduCareInc.com, 2004. 20-21. 30 Kneece. 20-21. 31 D. Beijerinck, P. A.Van Noord, J. M. Kemmeren, J. C. Seidell. “Breast Size as a Determinant of Breast Cancer.” Int. J. Obes. Relat. Metab. Disord. Mar. 1995, 19(3): 202-5. 32 M. A. Roubidoux, J. E Bailey, L A. Wray, M. A. Helvie. “Invasive Cancers Detected After Breast Screening Yielded a Negative Result: Relationship of Mammographic Density to Prognostic Factors.” Radiology. Jan, 2004; 230 (1): 42-8. 33 M. J. Borugian, S. B. Sheps, C. Kim-Sing, I. A. Olivotto, C. Van Patten, B. P. Dunn, A. J. Coldman, J. D. Potter, R. P. Gallagher, T, G, Hislop. “Waist-to-Hip Ratio and Breast Cancer Mortality.” Am. J. Epidemiol. Nov. 15, 2003; 158(10): 963-8.
  14. 14. the one of the largest and most used muscle group in the body—the gluteals. The abdominals by contrast do not get nearly the daily workout in normal activities. Thus the fat at the hips would have much more potential for fluid movement than the waist fat. Marital Status Lastly, married women, in almost every study done, have been shown to have less breast cancer than single females.34 Making the assumption that married women get more breast massage (which would stimulate lymphatic flow) than unmarried women, this supports the argument for lymphatic massage as a possible aid in prevention of breast cancer. Admittedly it would not mimic the exact technique of MLD, but general massage has some positive effect on uptake of fluid.35 Manual Lymphatic Drainage There are different schools of thought in MLD. One of the early experts was Vodder. There are now other training programs which vary from his techniques. The largest differences between MLD and regular massage are 4 things.36 First, MLD is very light and superficial, not to exceed 30 to 45 mm. of pressure. Next, it is performed slowly. Both of these factors are in imitation of the way the lymphatic system functions. The third difference is in directionality. The massage begins in unaffected lymphatome areas to direct the fluid away from the involved areas. The last difference is sequence. Areas are massaged in a specified order for activation of the system. Thus, there is specific stroke sequence, duration, pressure, and direction. 34 C. Osborne, G. V. Ostir, X. Du, M. K. Peek, J. S Goodwin. “The Influence of Marital Staatus on the Stage oat Diagnosis, Treatment, and Survival of Older Women with Cancer.” Breast Cancer Res. Treat. Sept 2005. 93(1): 41-7. 35 W. Olszewski. 53. 36 Petrek. 18.
  15. 15. One could determine from study that any massage will likely help lymphatic flow but especially as it directs the fluid towards the base of the neck. Discrepancies Much of traditional teaching about the lymphatic system has now come into question. It was previously thought that initial lymphatics and pre-collectors do not have valves. From one study37 , it now appears that this may not be true. Current thinking holds that only the uptake of fluid by the pre-collectors is influenced by the extrinsic factors such as motion, muscle contraction and massage.38 Traditionally, it was accepted that the whole length of the vessels were affected by these factors. The prevailing thought, until recently, was that pressure gradients were a main element promoting lymphatic flow. This also is now in doubt.39 It is not understood what makes the lymphangions contract. Is it some sort of internal pacemaker?40 Even the existence of the contractile units, ”lymphangions” is under scrutiny.41 The more one studies this subject, the more one discovers how little is definitively known about this system. Yet, because it is such a crucial system, this must be changed. Other Related Questions 37 J.Trzewik, S. K.Mallipattu, G. M. Artmann, F. A. Delano, G. W. Schmid-Schonbein. “Evidence for a Second Valve System in Lymphatics: Endothelial Microvalves.’ FASEB Journal: Official Publication of the Federaion of American Societies for Experimental Biology. Aug, 2001; 15 (10): 159-184. 38 Trzewik. 171. 39 Trzewik. 171. 40 Trzewik. 171-172. 41 Trzewik. 173.
  16. 16. Many other questions could be proposed related to the lymphatic system and cancer. Does an excess of dietary protein overload the system so that it deals inefficiently with invaders?42 Could the link between body height over five foot eight inches and increased breast cancer43 exist because the lymphatic fluid becomes more concentrated near the breasts in taller people as it moves over a longer distance? Could radiation treatment of the breast area over the thymus gland be predisposing cancer patients’ immune system to succumb to future cancer? Is there a correlation between past tonsillectomies or splenectomies and cancer occurrence? Is there a correlation with lymphatic inefficiencies like cellulite, which is accumulation of interstitial fluid as well as connective tissue failure44 , and cancer? Could the higher incidence of skin cancer under the eyeglass nose- pads be related to interruption of lymphatic flow? Could damaged lymphatic structures be stimulated to regenerate through manual lymphatic drainage? Conclusions In conclusion, a large-scale study needs to be conducted on the link between breast cancer and lymphatic drainage. This study could be limited to women who are diagnosed with benign breast disease with or without atypical hyperplasia. The women in the control group could be given usual treatment without any instruction on manual lymphatic drainage (MLD). In the test group the women could be taught to do self-MLD daily for a minimum of ten minutes.45 In addition to this, the test group would stop 42 French. 26. 43 L. A. Brinton, C. A. Swanson. “Height and Weight at Various Ages and Risk of Brest Cancer.” Ann. Epidemiol. Sep, 1992; 2(5): 597-609. 44 French. 123-4. 45 L Anderson, I. Hoiris, M. Erlandsen, J. Andersen. “Treatment of Breast-Cancer-
  17. 17. wearing constrictive clothing around the breast region (bras) because this could constrict lymphatic flow. The two groups could be followed up periodically then statistically compared for recurrence rate. This could be expanded to women with ductal cancer in situ (DCIS) or Stage 1 cancer in the breast (smaller than one centimeter and not spread to the lymph nodes). MLD would have to be implemented at the point that the cancer is deemed not active because of contraindications to massage on top of active cancer.46 Conceivably, all women should start at puberty doing a few minutes of daily preventative manual lymphatic drainage (especially if bra wearing continues to be a fashion standard). Certainly every woman who has had axillary intervention (removal of lymph nodes or radiation to the under-arm region) could benefit from MLD. There are no negative consequences from implementing these preventions just on the basis of this review of the literature, logic, as well as anecdotal evidence. There is only the possibility of decreasing the occurrence of breast cancer. Related Lymphedema with or without Manual Lymphatic Drainage.” Acta. Oncol. 2000; 39(3): 399-405. 46 K. Ruger. “Diagnosis and Therapy of Malignant Lymphedema.” Fortschr. Med. Apr. 30, 1998; 116(12): 28-30,32,34.
  18. 18. Link Between the Lymphatic System and Breast Cancer (a literature review and hypothesis) By Kathleen McLaughlin PT 4/25/08
  19. 19. 847-370-5738

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