Advances in Breast Cancer Treatment and Lymphedema Management

World Lymphedema Day, observed on March 6th, highlights ongoing progress in preventing and managing lymphedema, a common complication of breast cancer treatment. Recent advancements in oncology and breast surgery are making this condition increasingly manageable, offering improved quality of life for patients.

Understanding Lymphedema

Upper limb lymphedema is a chronic, progressive condition affecting the lymphatic system, potentially causing significant functional limitations. However, evolving therapeutic strategies are enabling more accurate patient selection and reducing the need for extensive surgical interventions.

Sentinel Lymph Node Surgery and Molecular Analysis

The introduction of sentinel lymph node surgery, coupled with advanced molecular analysis techniques like OSNA (One Step Nucleic acid Amplification), has been a turning point in lymphedema prevention. This approach allows for the rapid and precise identification of minimal metastases, avoiding complete dissection in many cases. As Professor Paolo Carcoforo of the University Hospital of Ferrara explains, this represents a fundamental shift in practice.

Targeted Therapies in Breast Oncology

Breast oncology is experiencing a period of rapid evolution, with a growing emphasis on personalized therapy based on the biological and molecular profiles of tumors. Professor Luana Calabrò, Director of Clinical Oncology at the University Hospital of Ferrara, underscores this trend.

Immunotherapy for early triple-negative tumors and anti-HER2 therapies for HER2-positive tumors have significantly improved response rates to neoadjuvant therapy, increasing the likelihood of achieving a complete pathological response before surgery. Recent classes of drugs, such as Antibody-Drug Conjugates (ADCs), are emerging as promising innovations.

Antibody-Drug Conjugates (ADCs)

ADCs are designed to selectively deliver chemotherapy directly to tumor cells via an antibody that specifically recognizes them. While currently under investigation in clinical studies for early-stage breast cancer, preliminary results suggest they could become a valuable component of early therapeutic strategies. Dr. Anna Moretti of the University Hospital of Ferrara notes that if ongoing studies confirm these findings, ADCs could further enhance the effectiveness of neoadjuvant therapy and potentially reduce the extent of surgical treatment.

Rehabilitation Network for Lymphedema Treatment

Scientific advances have led to a decreased need for rehabilitation treatments for upper extremity lymphedema. However, optimized rehabilitation management remains crucial, as lymphedema is a chronic condition requiring a personalized approach. The University Hospital and the Local Health Authority of Ferrara have established a functional intercompany network to provide frequent visits and targeted treatments based on the severity of the condition, extending across the provincial territory.

Dr. Elisabetta Zucchini, Director of Territorial Rehabilitation of the Local Health Authority of Ferrara, emphasizes the importance of conveying a message: lymphedema can be effectively prevented and treated, particularly when addressed early. Physical and rehabilitation medicine plays a central role in recovery after breast surgery, helping women regain autonomy and quality of life. Therapy includes manual lymphatic drainage, elastic compression bandages, and therapeutic exercise.

Data and Results from the University Hospital of Ferrara

Data from the University Hospital of Ferrara (2023-2024) indicates that only 15-16% of patients undergoing breast cancer surgery required axillary lymph node dissection. Of these, 57% received rehabilitation at the “Cittadella San Rocco” Community House. This reduction in dissections has contributed to a lower incidence of lymphedema.

There has also been an increase in rehabilitation treatments for musculoskeletal dysfunctions of the shoulder, successfully resolved in 90% of cases (excluding pre-existing muscle or tendon pathologies). Visits to the physiatric outpatient clinic at “Cittadella San Rocco” decreased from 590 annually in 2017 to 224 in 2025, with approximately 45% requiring treatment for lymphedema.

The Role of Breast Reconstruction

Breast reconstruction, whether immediate or delayed, helps reduce the risk of lymphedema. Immediate reconstruction offers psychological, surgical, and technical advantages, often utilizing prosthetic reconstruction with a prosthesis or expander positioned without acting on the pectoral muscle, minimizing pain and functional alterations. In select cases, autologous tissue reconstruction (using the patient’s own tissues) is also an option.

Empowerment and Prevention

Patient empowerment through education on healthy behaviors is a fundamental aspect of rehabilitation. Regular physical activity and proper nutrition not only reduce the risk of tumor recurrence but also improve metabolism and decrease the likelihood of associated pathologies. Future goals include strengthening secondary prevention through structured exercise programs.