Reply: Early Detection of Lymphatic Disorder and Treatment for Lymphedema following Breast Cancer

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We appreciate Dr. Yamamoto et al. for agreeing with our idea of a screening test for lymphatic function using indocyanine green lymphography for high-risk patients of breast cancer–related lymphedema.1 Although we have already proposed a screening test for high-risk patients of secondary lower extremity lymphedema as a result of our prospective cohort study conducted in 2013 for patients following gynecologic cancer, it is yet to be universally used.2 There are certain criteria to be met for realizing these ideas of performing screening tests for early-stage or subclinical lymphedema.
First, it should be proved that the prognosis of lymphedema will show long-term improvement and the total expenses of lymphedema care can be reduced when lymphedema is detected in the early stages or as a subclinical disease. We have published the results of our treatment for patients with subclinical and early-stage lower extremity lymphedema following the cohort study; however, the mean follow-up period was 20.9 ± 2.2 months after lymph node dissection.3 Because lymphedema is a chronic, progressive disease, the results of a longer follow-up period should be analyzed in future studies.
Second, maximum effort should be devoted to decreasing patient discomfort associated with the screening procedure. Ideally, the screening test should be conducted using a painless method, during the follow-up examination after cancer treatment. Oncologists, nurses, therapists, and physicians specializing in lymphedema treatment should work as a team to detect early-stage and subclinical lymphedema and establishing treatment methods.

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