Study Gives Lift to Mastectomy Patients

Aug. 13, 2009— -- For decades, women who underwent a mastectomy were told they could not do much lifting or they might risk developing a painful arm swelling condition called lymphedema.

That meant no lifting of grocery bags, toddlers, heavy boxes or even buckets on the side of the mastectomy for the rest of their lives.

But according to a new study, in most cases, doctors should have said the opposite. Expert-guided weightlifting may reduce the uncomfortable leathery skin texture, heaviness, and pain symptoms of lymphedema, according to an article published Wednesday in the New England Journal of Medicine.

Although several small studies have found evidence that weightlifting didn't put women at risk for lymphedema, Wednesday's study was one of the largest of its kind and the first to show weightlifting may actually help symptoms.

When Jeanette Stephens-El was diagnosed with breast cancer in 2003, she already knew exactly how challenging living with a mastectomy could be, including lymphedema.

"I had two sisters before me who had had breast cancer," said Stephens-El, author of "BCV: Rites of Passage for Breast Cancer Victors" under the pen name Raining Deer. "My mom had five daughters and four of us have had breast cancer and we all survived."

Stephens-El's older sister, who was diagnosed in the 1980s, has suffered from lymphedema for 20 years. So after her own breast cancer battle and mastectomy, Stephens-El thought she'd get a head start and volunteer for the study.

She was one of 141 women with lymphedema participating in the study. The women were assigned either to twice-weekly weight training programs at a local YMCA, or to no weight training as a control group.

As researchers followed the women over a year, 14 percent of the women working out with weights reported exacerbating symptoms of their lymphedema. However, 29 percent of women who were not weightlifting reported exacerbating symptoms.

"Six years after the mastectomy, I still feel the effects. I feel the pulling from the muscle," said Stephens-El. However, she said she hasn't developed serious lymphedema since she started weightlifting, and she feels better all around.

Kathryn Schmitz, author of the study and an associate professor of epidemiology at the University of Pennsylvania, said she hoped her study would influence future guidelines for mastectomy survivors.

Doctors Debate How Much Weightlifting Will Help Breast Cancer Patients

Schmitz said she saw the current "risk-adverse" approach with warnings about lifting heavy objects as a "crazy, backward situation that further stresses the survivors."

Researchers in the breast cancer field widely agreed that the study was well done, but disagreed about the impact it would have.

"The weightlifting study is nicely done," said Dr. Harold Burstein, of Harvard Medical School and the Dana-Farber Cancer Institute in Boston. "Fortunately, lymphedema is quite uncommon in modern surgical practice for breast cancer."

According to the Schmitz article, different studies have estimated that lymphedema affects up to 70 percent of women after breast cancer surgery.

In years past, surgeons used to take out many more lymph nodes during a mastectomy. The more lymph nodes missing, the greater the woman's risk for developing lymphedema. As medical techniques improved, not only has the rate of mastectomies declined, but so has the amount of tissue taken when a mastectomy is performed.

"However, there are few treatments that are proven effective for ameliorating this problem, and thus, this looks like a valuable option for affected patients," Burstein said.

Dr. Beryl McCormick of the Memorial Sloan Kettering Cancer Center in New York City agreed that the study would change advice given to breast cancer survivors.

"This is new information. Many surgeons recommend limited weight-bearing," McCormick said.

But Dr. Ruth Oratz of the Women's Oncology and Wellness Practice in New York City said she thought the study would have minimal effect on practice.

Oratz pointed out that while the weightlifting women reported fewer exacerbations from the lymphedema, the weightlifting didn't actually quell the swelling itself.

"The mild strength training looks like it may help prevent exacerbations," Oratz said. "But it will not change baseline arm swelling."

As a result, she said she would see "no major change in practice."

Yet individuals in the study have reported less swelling since they began their participation.

Women Say Lifting Weights Helps Arm Swelling

Breast cancer survivor Corrie Roberts said that when she heard about a study on weightlifting and lymphedema she signed up, even if the study was experimental and she hated working out.

"One of the classes I hated in school was gym," said Roberts, 75. "But I really think this exercise and this weightlifting have kept this swelling down. I woke up this morning and the swelling was gone."

Roberts said her lymphedema began to develop after an anesthesiologist pricked her left arm before a procedure. Shortly afterwards she noticed a mild swelling that just wouldn't go away.

"It was uncomfortable, there was a tightness there," she said. "It was there all the time. It didn't go down and I knew that something was wrong."

Roberts, who lives in the Philadelphia area, said she now advises her friends to try weightlifting.

"There are two people I know who have arms that look like sausages and I keep telling them that they have to go to a physical therapist and get some exercise," she said.