Browning, C. (1997). Lymphoedema: Prevalence, risk factors and management: A review of research. Kings Cross, Australia: NHMRC National Breast Cancer Center.

DATABASES USED: Detailed review of evidence undertaken using a MEDLINE search from 1985–1996. Additional references were retrieved from a survey of references in each article and from unpublished and in-press research from key researchers in the area.

INCLUSION CRITERIA: English language; sample size of 20 or more participants; lymphedema related to breast cancer treatment; if other patients were included, at least 20 participants needed to be patients with breast cancer, and data for these patients were reported separately

EXCLUSION CRITERIA: Animal studies and non-English articles were excluded. Articles were excluded if their data were already published, if they were lymphedema-physiology based, if they discussed measurement techniques only, or if they were review articles.

• FINAL NUMBER STUDIES INCLUDED = 41 
• KEY SAMPLE CHARACTERISTICS: Treatments evaluated risk factor identification, lymphedema prevalence data, and treatment. No review of infection prevention or treatment is discussed in this document.

• Complex physical therapy (also known as complete decongestive therapy) includes four components used together:
• Skin care 
• Manual lymphatic drainage (MLD)
• Compression bandages
• Exercise.

In this review, all studies reported significant improvement. There was no comparison or control group.

• Compression techniques: Elastic sleeves (limitations in study quality)

Not Recommended for Practice

• Drug therapy
• Oral benzopyrones (e.g.,coumarin): Small RCTs; drugs pose significant liver toxicity

• Avoiding injury and heavy lifting, keeping weight under control, and avoiding injection, vaccination, and BP in affected arm seems prudent. 
• Air flight, injury, and trauma often are identified as precipitating factors but are not well studied. Further research and inquiry are necessary. 
• Caution against unsubstantiated recommendations citing a small study of women with lymphedema who needed hand surgery and successfully underwent surgery without any worsening of pre-existing lymphedema or onset of new swelling or infection.
• Provide patient education regarding risk factors and life-style.

• Age: Three out of four studies reviewed suggested that older patients are more likely to develop lymphedema.
• Wound complications and increased wound drainage
• Obesity 
• Prior infection
• Axillary surgery
• Radiotherapy
• Recurrent disease

• Strategies for early detection needed 
• Lymphedema research needed