Study Changes Rules on Breast-Cancer Care

Women treated for breast cancer are warned to avoid heavy lifting -- including groceries, babies, and hefty handbags -- for fear they'll develop chronic arm swelling.

A new study led by University of Pennsylvania researchers shatters this guidance. By lifting weights twice a week for a year, breast-cancer survivors with the swelling had fewer debilitating symptoms and flare-ups, even as they grew stronger.

In fact, some of the 70 iron-pumpers completely controlled the unsightly, incurable fluid buildup called lymphedema.

"It's just a wonderful program," said Jackie Amarnek, 77, of King of Prussia, who still works out regularly. "My arm looks perfectly normal now; you'd never know there's anything wrong."

The study, published in today's New England Journal of Medicine, is the largest and most rigorous to show clear-cut benefits -- and no risks -- to slow, progressive strength training for women with breast-cancer-related lymphedema.

The condition develops when fluid flowing through the channels of the lymph system backs up behind an obstruction. In breast-cancer patients, the problem stems from the removal of one or more small bean-shaped lymph nodes under the arm next to the diseased breast. The nodes are dissected to check for the spread of cancer.

Lymphedema is both unpredictable and common, affecting 20 to 30 percent of the nation's 2.4 million breast-cancer survivors. Amarnek, for example, developed swelling about a year after surgery; her mother, another breast-cancer survivor, never had the problem, despite having many more nodes removed.

The fluid accumulation, which can become disfiguring, is more than a cosmetic problem. The lymph system is part of the infection-fighting immune system, so disrupting it "changes the arm's ability to respond to injury or infection," said Kathryn Schmitz, the epidemiologist at Penn's Abramson Cancer Center who led the weight-lifting study.