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There are more than 4 million breast cancer survivors in the United States today. And with approximately 320,000 new cases diagnosed each year and 5-year relative survival rates exceeding 99% for patients with localized disease, the ranks of survivors will grow rapidly over the next decade.
Medical oncologists serve as those patients’ lead physicians in terms of monitoring for cancer recurrence and managing the long-term sequelae of the disease and its treatment. However, primary care providers (PCPs) typically are the clinicians who survivors see most often once they complete initial treatment. In recognition of the vital role PCPs play in managing survivors’ health, Regional Cancer Care Associates (RCCA) – one of the nation’s largest networks of oncology specialists serving patients in New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area.
– is launching a series of occasional articles on conditions and quandaries primary care clinicians may encounter in providing care to breast cancer survivors. In the series’ inaugural article, two board-certified medical oncologists and hematologists practicing with RCCA highlight six key points related to breast cancer-related lymphedema (BCRL).
Both treatment-related factors and patient characteristics contribute to risk for BCRL. Deena Mary Atieh Graham, MD, explains, “The incidence of post-treatment lymphedema reported in the scientific literature ranges from the single digits to 50%, with many studies putting the rate around 20%. However, those are overall numbers looking at full study populations. The chances of developing lymphedema are significantly affected by both the type of surgical procedure and/or radiation regimen involved and several patient characteristics.”
“For example, patients undergoing axillary lymph node dissection experience a BCRL incidence of roughly 19.9%, compared to 5.6% for patients who receive sentinel lymph node biopsy alone. Meanwhile, when regional nodal irradiation, or RNI, is administered following mastectomy, it increases the risk of lymphedema by up to five times. And when RNI is coupled with axillary lymph node dissection, the risk can escalate to upwards of 30% to 40%,” says Dr. Graham, who practices with RCCA at the John Theurer Cancer Center of Hackensack University Medical Center in Hackensack, NJ.
Rachel Levenbach, MD, who practices at RCCA’s Moorestown, NJ office, notes that patient factors contributing to an elevated risk for BCRL include:
Dr. Levenbach adds, “In order to counsel patients effectively and to have an appropriate index of suspicion for lymphedema, primary care clinicians need complete information on staging at diagnosis and the interventions that patients received. Electronic medical record platforms (EMRs) certainly have helped in this respect, but too often, the burden remains on the patient to remember and convey the specifics of her treatment regimen to her PCP. That is not realistic or reasonable and is unfair to both the patient and her clinician. At RCCA, we pride ourselves on providing our primary care colleagues with detailed information on a patient’s diagnosis and treatment and of being available to them for quick consults or ongoing collaborative management.”
Chronic BCRL often manifests about 14 months after completion of treatment. Dr. Levenbach says,
“The clinical timeline of BCRL is highly variable. While transient, mild swelling can occur within the first three months postoperatively due to acute surgical trauma or chemotherapy, true chronic BCRL typically manifests at an average of 14.4 months following treatment completion.” She notes that while this is a time to be particularly attentive to possible lymphedema, breast cancer survivors remain at risk throughout their lives, with the baseline probability of onset increasing by roughly 1% per year for decades.
Many breast cancer survivors have misconceptions about exercise and lymphedema. “Many years ago, oncologists advised breast cancer survivors to avoid resistance and aerobic exercises due to concerns that the physical activity could provoke or exacerbate lymphedema. Several studies have since allayed those concerns within the medical community, but the idea still has considerable traction among patients,” Dr. Levenbach says.
In fact, the cancer specialist adds, structured strength training optimizes the mechanical “muscle pump” action around deep lymphatic vessels, which actually improves extracellular fluid clearance and can prevent functional shoulder limitations.
“As with so much in medicine and in life, common sense and moderation are key when it comes to exercise for breast cancer survivors,” says Dr. Levenbach. She explains, “For example, patients should be advised to start slow, ‘listen’ to their bodies, and increase their exercise intensity gradually. They also should wear a physician- or therapist-recommended compression garment during exercise to offset any exercise-induced capillary filtration.” Dr. Levenbach adds that referral to an exercise physiologist or physical therapist who has experience in working with breast cancer survivors can be particularly helpful in encouraging patients to adopt an individualized physical activity plan.
A tape measure often will suffice for diagnosing BCRL. Dr. Graham says that while imaging plays a key role in the ongoing monitoring of breast cancer survivors, a lower-tech tool – the tape measure – can reliably confirm the presence of lymphedema in many cases.
“I recommend performing serial, bilateral circumferential measurements of the arms at a few fixed points, such as at the metacarpophalangeal joints, wrists, 10 cm distal to the olecranon, and 10 cm proximal to the olecranon. A difference of 2 cm or greater at any corresponding point, or a calculated volumetric discrepancy of >10% between the affected and unaffected limbs, indicates lymphedema,” Dr. Graham says. The medical oncologists adds that when questions remain after bilateral measurement of the limbs, referral for more sophisticated assessments, such as bioimpedance analysis, is indicated.
Complete decongestive therapy (CDT) remains the preferred first-line intervention for lymphedema. Once BCRL is identified, prompt – and ongoing – management is needed. “Complete decongestive therapy is a multimodal, conservative intervention designed to maximize lymphatic diversion and is the preferred initial approach to treatment,” Dr. Graham says.
The medical oncologist adds that CDT is best coordinated by a Certified Lymphedema Therapist (CLT) and entails two phases:
Cellulitis is an ever-present concern. Dr. Levenbach notes that the long-term management of BCRL focuses on the prevention and aggressive treatment of secondary dermatological infections. “Because lymphostasis impairs localized immune surveillance, the lymphedematous limb is highly vulnerable to bacterial entry,” she says, stressing that cellulitis in a lymphedematous limb is a medical emergency that can rapidly induce systemic sepsis and permanently damage remaining lymphatic channels. “We need to educate our patients to be alert to the prodromal systemic signs of infection, explaining to them that fever, shivering, other flu-like symptoms, or sudden malaise can be the first indicators of cellulitis, emerging before the classic localized signs such as erythema, warmth, and pain,” she says.
Dr. Graham says, “Lymphedema is among the most physically debilitating and psychologically distressing complications of breast cancer. While advanced surgical techniques such as lymphovenous anastomosis and vascularized lymph node transfer are offering new hope to patients with advanced or refractory cases, conservative measures will suffice for most breast cancer survivors with BCLR. With close communication and collaboration, primary care clinicians and medical oncologists can protect the physical health and enhance the quality of life of our patients experiencing lymphedema.”
Dr. Graham and Dr. Levenbach are among 90+ medical oncologists and hematologists who practice with Regional Cancer Care Associates (RCCA), one of the nation’s largest networks of oncology specialists. RCCA has more than 20 locations near you across New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area. RCCA’s cancer specialists see more than 30,000 new patients each year and provide care to more than 265,000 established patients, collaborating closely with those patients’ other physicians. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, as well as access to approximately 300 clinical trials. In addition to serving patients who have solid tumors, blood-based cancers, and benign blood disorders, RCCA care centers also provide infusion services to people with a number of non-oncologic conditions—including multiple sclerosis, Crohn’s disease, asthma, iron-deficiency anemia, and rheumatoid arthritis—who take intravenously-administered medications.
To learn more about RCCA, call 844-346-7222 or contact RCCA.
All statistics are for the United States and, unless otherwise noted, for 2026.
Source: National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. Cancer Stat Facts: Melanoma of the Skin. Available at https://seer.cancer.gov/statfacts/html/melan.html. Accessed July 19, 2026.
For more information or to schedule an appointment,
call 844-346-7222. You can also schedule an appointment by calling the RCCA location nearest you.
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