Many people are aware that hair loss is a common side effect of chemotherapy. However, another common late side effect of cancer treatment is abnormal swelling in one or more limbs called lymphedema. Lymphedema is usually caused by blocked or interrupted return of lymphatic fluid and may occur immediately after cancer treatment, or after 1-5 or even 20 years. Alopecia usually appears two weeks to four weeks after treatment begins, but symptoms of lymphedema may not appear soon. The latency period may be months or years before significant swelling appears. During the latent period, changes in the affected limb cannot be detected by objective measurements and can only be judged by the persistence of other symptoms. Because of the late onset of overt symptoms, patient self-reporting plays an important role in the early detection of lymphedema. Researchers from the New York University School of Nursing have conducted a new study to examine the veracity, sensitivity and specificity of lymphedema symptoms for the detection of breast cancer-related lymphedema. The study, titled “Symptom Reporting in Breast Cancer-Associated Lymphedema Testing,” was published in Breast Cancer: Targets and Therapy. The study also identified the optimal clinical cut-off point, the symptom count at which the sum of sensitivity and specificity reached a maximum. The NYU researchers collected data from 250 women, divided into three groups. Of these, 60 were healthy adults, 42 were breast cancer survivors who had been diagnosed with lymphedema, and 148 were breast cancer survivors at risk of developing lymphedema. The healthy individuals in the study were significantly younger than the breast cancer survivors with lymphedema and those at risk for lymphedema. Also of note, there were more non-whites among breast cancer survivors with lymphedema. ”In the first part of the study, we assessed the 22 symptoms involved in breast cancer-related lymphedema; in the second part, we assessed the different levels of symptom distress.” said Mei R. Fu, PhD, first author of the study and associate professor of chronic disease management at the New York University School of Nursing. Women who reported symptoms of arm heaviness, arm stiffness, increased arm temperature, pressure, limited arm movement, tingling, and arm pain were more than five times more likely to have lymphedema than women who did not report these symptoms; women who reported limited finger movement, limited elbow movement, and limited wrist movement were more than four times more likely to have lymphedema than women who did not report these symptoms; and women who reported women with pain in the affected limb were nearly twice as likely to have lymphedema as women who did not report pain in the affected limb. ”Although these symptoms and the degree of symptoms were diagnostically correlated, we found that we could distinguish between healthy individuals, breast cancer survivors with lymphedema, and breast cancer survivors at risk of developing lymphedema by the count of symptoms.” Dr. Fu said. When the cutoff value was three symptoms, breast cancer survivors with lymphedema could be distinguished from healthy women with 94 percent sensitivity and 97 percent specificity; when the cutoff value was nine symptoms, breast cancer survivors at risk for lymphedema could be distinguished from breast cancer survivors who already had lymphedema with 64 percent sensitivity and 80 percent specificity. In the absence of an objective measure of latent lymphedema, Dr. Fu and team researchers hope that the cost-effective symptom counting method will become an initial screening tool for lymphedema and encourage its clinical application.