The statistics regarding breast cancer are alarming:
- The rate of new cases of breast cancer has been increasing by just over 1% per year since the 1940s.
- In 2005, an estimated 211,240 new cases of invasive breast cancer will be diagnosed among women.
- 1 in 8 women either has or will develop breast cancer in her lifetime.
Despite those statistics, there is also some very good news: great strides have been made in the detection and treatment of breast cancer. Even though the incidence of new cases has increased each year, mortality rates have significantly decreased. If detected early, the 5 year survival rate is 95%! There are more than 2 million breast cancer survivors in the US today!
Discovering that you or someone you love has breast cancer can be a terrifying experience. However, new hope and excitement has come from the expanding array of life saving treatments that can be tailored to fight the complexity of each individual cancer. The ideal treatment plan is different for each woman depending on several factors, such as: stage of the cancer, tumor size, lymph node involvement, and hormonal (menopausal) status. Treatment plans usually consist of a combination of surgery, radiation, hormonal therapy, and chemotherapy.
Once the initial treatment is over, the breast cancer survivor must take steps to ensure her healthiest future and highest quality of life possible. Seeking regular medical care is of utmost importance. Being aware of possible post-treatment complications and intervening early if complications arise are also important steps in this process. Post-treatment complications may include the following:
1) Pain - at the incisional site, shoulder girdle, and neck. This pain can be caused by tension along the incision with movement of the arm on the involved side, or muscle spasms. Problems can arise when the person limits using their arm out of fear or pain including loss of motion in the shoulder and increased risk of lymphedema.
2) Lymphedema - a chronic condition that is characterized by swelling of a body part (typically the arm on the involved side). The condition occurs when lymphatic fluid can no longer travel effectively through a segment of the lymphatic system and instead accumulates in the surrounding tissues causing swelling. It occurs most often when lymph nodes are removed to determine how far the cancer has spread. It is estimated that 30-40% of survivors will develop lymphedema following their surgery, though it can take years to develop. Lymphedema can lead to difficulty using the involved arm and decreased body image. A good way to monitor this gradual swelling is to periodically take circumference measures of the arm on the involved side. You may also notice it in the fit of watches, jewelery, or clothing.
3) Scar tissue formation - can restrict motion, cause pain, and also increase the risk of lymphedema. It may also cause deformity of the breast and surrounding tissue and decreased body image.
4) Faulty Postures - Women often adopt protective postures, such as rounded shoulders, in order to avoid pain or skin tightness. Over time, this can lead to poor shoulder movement, neck, upper back and even lower back pain. Faulty postures can also develop following reconstruction procedures that utilize abdominal or other trunk muscles to reconstruct the removed breast tissue. Over time, those postures can lead to headaches and numerous spinal problems.
5) Weakness – muscle imbalance, and general deconditioning from lack of activity.
6) Osteoporosis - Chemotherapy can lead to early menopause in premenopausal patients, which can accelerate bone loss.
The initial phase following a diagnosis of breast cancer is overwhelming and rightfully consumed with the fight to live. Many of these complications can often be overlooked as minor issues during that time, however, they can become major obstacles in the performance of every day activities if not addressed. Complications can lead to loss of movement or strength in the arm, problems with scar healing, and difficulty performing usual activities of daily living such as dressing, toileting, reaching overhead or behind the back, bed mobility, driving, lifting, and other functional activities. This can limit a person’s ability to return to work, social activities, exercise, and can hugely impact her quality of life.
Early intervention can help the breast cancer survivor reduce or avoid these complications. There are several things that can easily be incorporated into a home exercise program. Interventions can include: progressive range of motion and stretching exercises, scar tissue massage, posture education and correction, manual therapy and modalities to reduce pain, inflammation, and swelling, and strengthening exercises. A physical therapist with expertise in treating women following breast surgery can customize the exercise program to the individual’s needs, and alleviate some of the fears they may have regarding movement or returning to activity.
Women are surviving breast cancer! Being educated about treatment options and possible complications are key to helping each survivor preserve her functional quality of life and optimize her overall health.
Susan Palmer, PT
Palmer Physical Therapy for Women