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Breast Massage
By Robin C. Myers, CH, LMT, SF, RRMT

Lymph Drainage Therapy
By Dr. Howard B. Sanford
Compiled from an article written December 20th, 1999

How I Would Explain our Lymphatic System
By Ken L. Smith

return to: Breast Massage Therapy

 

Link Between the Lymphatic System and Breast Cancer
By 
Kathleen A. McLaughlin, P.T.

Overview: by Ken L. Smith

This is merely an overview of this author's article that follows. Any words that are italicized and underlined are her words, taken from her article, which is posted in full following this Overview. Any points of emphasis in the Overview are mine. Please be aware that the purpose of this Overview is to point out to you only the main "talking points" that she covers in her article, and by taking them out of her original context, questions can appear as facts and facts may appear as theories.

To learn the full impact of the author's words, please read her entire presentation, which follows this Overview:

 

 

 

 

 

 

 

 

Link Between the Lymphatic System and Breast Cancer

Written By Kathleen A. McLaughlin, P. T. 

An Overview

 The lymphatic system has been underemphasized in medical study and practice...      I conclude that the surface has just been scratched in understanding the lymphatic system...   and its link to breast cancer.

 A consequence of breast cancer treatment for many women is lymphedema... Tests for lymphedema should be expanded... to detect early stage lymphedema... and the author suggests that these tests ...should include instruction in manual lymphatic drainage (MLD) and in avoidance of constriction including tight clothing.

... (MLD) could also prove to be a significant contributor in preventing and fighting breast cancer.  It seems prudent to do a study of the effects of MLD and non-constrictive clothing use.

 ... MLD has been helpful in the treatment of severe lymphedema... and as an adjunct for preventing cancer like diet and exercise...

 I began my search on the basis of this assumption:  the lymphatic system is key to the prevention and healing of breast cancer...

 There is preponderance of information about the lymphatic system as a means for metastasis...  (the spread of cancer)

 ...the lymphatic system seems crucial in preventing toxin (or carcinogen) buildup, in fighting non- entrenched cancer cells, and in fighting established cancer, especially as related to the breastsThere seems to be an awakening to the importance of the lymphatic system and the need for more hard knowledge in relation to it.

 ...  Breast cancer can be linked to inadequacies in lymphatic function, and prevention and treatment can include wearing loose apparel in the breast region as well as implementing manual lymphatic drainage...

 ...young women could implement manual lymphatic drainage and appropriate clothing use as prophylaxis (a way to preserve good health) to breast cancer...

 ... breast cancer is a complicated disease without one clear (cause).  ...Training in MLD and non-constrictive clothing use would be just one more tool in the arsenal of weapons.

 The lymphatic system is separate from the blood circulatory system.  It helps to carry fluid from the body back toward the heart.  It also filters out toxins and manufactures lymphocytes to fight infections...

 Kathleen beautifully describes the lymphatic system, and if you are interested in learning how the system works, this section is a  must read for you. She also tells us what Lymphedema is all about, and how it becomes the scourge of those that have had surgery under the arm for lymph nodal evaluations or radiation during the treatment of breast cancer. She offers very definite instructions on methods of effectively monitoring for the onset of lymphedema.

 Lymphedema... is caused by dysfunction in the lymphatic system... from damage by surgery, radiation, infection, or injury to the lymphatic system...   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. ... This leads to an inflammatory response with pain, redness, and heat.  There can be scarring, damage to the blood vessels, tissues, and skin...

 Many factors help to move the lymphatic fluid.  Movements, even as small as blinking or stretching...  Breathing... and the heartbeat are all thought to have an effect through pressure changes.  Skeletal muscle contractions are also a factor...  Another method that can increase fluid intake is massage or passive motion...                                  

 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...  The left lymphatics drain the right leg, and the whole left side of the body...

 Could the anatomical difference mentioned above cause more lymphatic backup on the left side?  ... This in turn could lead to toxin build- up in the inadequately drained tissues...   Toxin concentration could occur  ...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.    ...the most susceptible area should be the left breast.                                          

...The left breast has a higher cancer occurrence rate than the right... the most overloaded regions of lymphatic drainage are most prone to developing cancer...  Presumably, the toxin accumulation is caused by lack of lymphatic fluid movement through the tissue... This is the concern experts have when they question the damage that a bra can do to the breasts.

...analysis showed a 6% decrease in breast cancer risk for every hour on a weekly basis of sustained physical activity. ... muscle pumping propels the lymphatic fluid, thus making the lymphatic drainage more complete with less toxin accumulation.

 The author discusses Breast Size, Exercise and which side of the body the affected breast may be on. She also discusses Patterns of Fat Deposits and why breasts have different cancer rates than fatty deposits around the waist. Also discussed is the fact that...

 ...married women...  have been shown to have less breast cancer than single females...  married women get more breast massage (which would stimulate lymphatic flow) than unmarried women, (and) this supports the argument for lymphatic massage as a possible aid in prevention of breast cancer. 

 Discussion takes place about Manual Lymphatic Drainage in which she describes four important points about it: ...MLD is very light and superficial...  is performed slowly... to direct the fluid away from the involved areas...   Areas are massaged in a specified order... and there is more technical information on what MLD accomplishes. 

In her summation, she says The more study that I devote to this subject, the more I discover how little is definitively known about this (lymphatic) system.  Yet, because it is such a crucial system, this must be changed.

 Half a dozen  Other Related Questions are presented, including ...  Could damaged lymphatic structures be stimulated to regenerate through manual lymphatic drainage?,  indeed a very critical question.

 In her unaltered words: In conclusion, a large-scale study needs to be conducted on the link between breast cancer and lymphatic drainage.  I propose a simple and safe way of doing such a study... limited to women who are diagnosed with benign breast disease...  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.  In addition to this, the test group would stop 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. 

 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.

 

Kathleen A. McLaughlin, Physical Therapist

  • Diagnosed with two separate breast cancers, treated with radiation, and then double mastectomies.

  • Passionate about the prevention of breast and other types of cancer.

  • Interested in melding nutritional information with alternative and traditional medicine.

  • She has posted a personal blog at: http://web.me.com/kathy.mclaughlin/kathysblog/Blog/Blog.html

The full article is posted below

This Overview was reviewed by the author before it was posted. The purpose of the Overview is to allow you to quickly determine if the information it discusses is of interest to you. Ms. McLaughlin's intent when writing the article was to provide the technical scientific and medical information for any professional that will read it. For those of us that have difficulties with some of the terms used in this field, we have provided in our language the message that she would like for you to take away from her article. Please feel free to contact Ken at BreastCare@comcast.net  or the author at her blog address:  http://web.me.com/kathy.mclaughlin/kathysblog/Blog/Blog.html

                     

Link Between the Lymphatic System and Breast Cancer

written by Kathleen A. McLaughlin

Abstract

The lymphatic system has been underemphasized in medical study and practice. As a result of my research on this subject, I conclude that the surface has just been scratched in understanding the lymphatic system. This is even more emphatically the case as far as knowledge of 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 lymphedema should be expanded to preoperative and postoperative arm systems that are standardized and more accurate. The purpose of this is to detect early stage lymphedema so that prompt intervention can ensue. Early intervention should include instruction in manual lymphatic drainage (MLD) and in avoidance of constriction including tight clothing.

Aiding the lymphatic system through manual lymphatic drainage (MLD) could also prove to be a significant contributor in preventing and fighting breast cancer. It seems prudent to do a study of the effects of MLD and non-constrictive clothing use.

There is enough evidence that MLD has been helpful in the treatment of severe lymphedema. MLD now needs to be investigated for prophylactic use—to prevent lymphedema and as an adjunct for preventing cancer like diet and exercise. It is a powerful tool that is being underutilized.

Beginnings of Investigation

I began my search on the basis of this assumption: the lymphatic system is key to the prevention and healing of breast cancer. This seems elementary, but I found a minimal amount of information linking lymphatic function and breast cancer prevention or treatment.

There is preponderance of information about the lymphatic system as a means for metastasis. The book Dressed To Kill 1 addresses bra wearing and its connection to cancer, written from an anthropological viewpoint. However, the interpretations of the data are not done by typical statistical analysis. The data collected seemed to have some validity, but the study needed to be expanded and the data needed to be analyzed by statisticians, as the methods employed by the author of the book are not usual.

One medical study linked the status of axillary lymph drainage with the chance of survival for breast cancer patients.2 There was also one excellent overall review of the progressing knowledge base.3 This article was presented at the First International Symposium on Cancer Metastasis and the Lymphovascular System in April of 2005 in San Francisco, CA. The review served as a good basis for understanding current thinking in relation to the lymphatic system and cancer. Furthermore, it pointed out the need for more knowledge of this crucial body system.

The role of the lymphatic system seems crucial in preventing toxin (or carcinogen) buildup, in fighting non- entrenched cancer cells, and in fighting established cancer, especially as related to the breasts. There seems to be an awakening to the importance of the lymphatic system and the need for more hard knowledge in relation to it.

Purpose and Primary Hypothesis

The purpose of this paper is threefold. Firstly, I want to add to the current impetus toward studying the lymphatic system. Additionally, the purpose is to propose a specific study that can be undertaken immediately with the limited knowledge base that we presently have. The study would be based on the following hypothesis: Breast cancer can be linked to inadequacies in lymphatic function, and prevention and treatment can include wearing loose apparel in the breast region as well as implementing manual lymphatic drainage. These will be elaborated on further as the paper progresses.

My third purpose is to propose a preventative measure to follow up the proposed study. In this, young women could implement manual lymphatic drainage and appropriate clothing use as prophylaxis to breast cancer. This would involve getting information to the public about the lymphatic system and training them in lymphatic care much as the public has been trained about flossing their teeth.

Even as I make these proposals, I recognize that breast cancer is a complicated disease without one clear etiology. Lymphatic dysfunction as a possible causative factor would be one among many causative factors. Training in MLD and non-constrictive clothing use would be just one more tool in the arsenal of weapons.

Anatomy and Physiology of the Lymphatic System

The lymphatic system is separate from the blood circulatory system. It helps to carry fluid from the body back toward the heart. It also filters out toxins and manufactures lymphocytes to fight infections. Another function is the transport of excess proteins.4 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.5

The lymphatic system consists of: 1) initial lymphatics (or lymph capillaries), 2) precollecting 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.6 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.7

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 approximately 90% of this fluid.8 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.9

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 600 10 to 700 11 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.12

The movement of the lymphatic fluid into the initial lymphatics then into the precollectors 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.

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.13 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% 14 to 30% 15 (for women with any kind of axillary intervention) and 49%(for those with complete axillary dissections.)16 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 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.17

Lymphedema may be under-reported because the current medical model seems to look only for extreme lymphedema. There must be early stages that are currently being missed.

There are currently three models in use for detecting lymphedema.18 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.

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.

The problem that I see with all three of these models as a patient 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. I can also say with first hand knowledge that the dye injection is very painful.

I propose a reasonable 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. 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 lymphedema 19 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. 20 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 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. 21

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). 22

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 carried on and eventually to be delivered to the subclavian veins. 23 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. 24 The left breast has a higher cancer occurrence rate than the right 25 and breast cancer is second only to lung cancer in cancer mortality rates in women. 26 (This may be because of the difficulty of early detection of 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. 27

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. 28 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. 29 If pillows of fat (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. 30 The fat or adipose tissue can be involved, but it is more rare. 31 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. 32 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. 33

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. 34 This could be explained by the fact that hip adipose tissue is close to 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. 35 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. 36

Manual Lymphatic Drainage

Manual Lymphatic Drainage (MLD) is taught in a few different schools of thought. The first recognized one was Vodder. There are now others with some minor changes in the techniques.

The largest variations between MLD and regular massage are 4 things. 37 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.

I have not had formal training in MLD. What I have implemented is my own version from reading, pictures, and my own training in massage as a physical therapist. It has worked for me with my benign breast disease and with mild lymphedema. More instruction may be on my future agenda.

Discrepancies

I have reported the above information as facts. That is how it was all related in the books and articles that I studied. However, some things that have been taught as fact are now in question.

It was previously thought that initial lymphatics and pre-collectors do not have valves. From one study38, it now appears that this may not be true. It is thought currently that only the uptake of fluid by the pre-collectors is influenced by the extrinsic factors such as motion, muscle contraction and massage.39 Before this time, 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. 40 It is not understood what makes the lymphangions contract. Is it some sort of internal pacemaker? 41 Even the existence of the contractile units, ”lymphangions” is under scrutiny. 42

The more study that I devote to this subject, the more I discover how little is definitively known about this system. Yet, because it is such a crucial system, this must be changed.

Other Related Questions

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? 43 Could the link between body height over five foot eight inches and increased breast cancer 44 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 failure 45, 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. I propose a simple and safe way of doing such a study. 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.46

In addition to this, the test group would stop 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. 47

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.

 

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.

3 Marlys Witte, Kimberly Jones, Jorg Wilting, Michael Dictor, Manuel Selg, Noel McHale, Jeffrey Gershenwald, David Jackson. “Structure Function Relationships in the Lymphatic System and Implications for Cancer Biology.” Cancer Metastasis Review. 2006, 25:159-184.

4 French. 26.

5 French. 26.

6 French. 5.

7 French. 22.

8 French. 7-10.

9 French. 11.

10 Jane Board, Wendy Harlow. “Lymphoedema 1: Components and Function of the Lymphatic System.” British Journal of Nursing. Jan. 2002,

11 Jane Lacovara, Linda Yoder. “Secondary Lymphedema in the Cancer Patient.” MedSurg Nursing. Oct 2006; 15(i5): 307.

12 French. 10-14.

13 J. Armer. “The Problem of Post-Breast Cancer Lymphedema: Impact and Measurement Issues.” Cancer Invest. 2005; 23(1): 76-83

14 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.

15 Nina Linnitt. “Lymphoedema: Recognition, Assessment and Management.”

16 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.

17 French. 3.

18 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.

19 Lacovara. 307.

20 W Olszewski. “Contractility Patterns of Normal and Pathologically Changed Human Lymphatics.” Ann N Y Acad Sci. Dec 2002. 979: 52-63.

21 French. 21.

22 French 12.

23 French 7.

24 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.

25 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.

26 No author cited. “Lung Cancer.” BBC News. Jan 30, 2004 update.        http://news.bbc.co.uk/2/hi/health/medical_notes/3243673.stm.

27 R. Roychoudhuri. 655-62.

28 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.

29 A. McTiernan. “Behavioral Risks in Breast Cancer: Can Risk Be Modified?” Oncologist. 2003; 8(4): 326-34

30 J. C Kneece. Breast Cancer Treatment Handbook. West Columbia, SC:EduCareInc.com, 2004. 20-21.

31 Kneece. 20-21.

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Kathleen A. McLaughlin, Physical Therapist

  • Diagnosed with two separate breast cancers, treated with radiation, and then double mastectomies.

  • Passionate about the prevention of breast and other types of cancer.

  • Interested in melding nutritional information with alternative and traditional medicine.

  • She has posted a personal blog at: http://web.me.com/kathy.mclaughlin/kathysblog/Blog/Blog.html