Advancing Prospective Screening and Establishing Risk Factors and Diagnostic Criteria for Individuals at Risk for Breast Cancer-Related Lymphoedema

Abstract

Lymphoedema has long been recognised as a sequela of cancer treatment, imparting a tremendous negative impact on quality of life for those affected. Despite significant research advances, mostly in breast cancer-related lymphoedema (BCRL) of the upper extremity, there is no universally accepted
diagnostic criterion, and prospective screening is not yet standard of care. Despite known lymphoedema risk factors, a substantial proportion of high-risk individuals remain without access to prospective screening, resulting in treatment delay to later stages of this progressive condition.
This dissertation integrates twelve publications, drawn from the author’s broader body of more than fifty works, into a cohesive and progressive narrative of BCRL research. Collectively, these publications advance the field across three domains. The first theme comprises four studies that establish the foundational aspects of BCRL care. They detail the rationale and core components of prospective screening, define objective and subjective screening measurement approaches, and establish diagnostic criteria to allow for early detection.
The second theme, consisting of five publications, elicits key BCRL risk factors from within the context of a large prospective BCRL screening program. These studies elucidate the contributions of axillary lymph node dissection, hand oedema, subclinical lymphoedema, and axillary web syndrome to BCRL development, informing individualised risk stratification.
The third and final theme, consisting of three publications, critically evaluates the effect of long-standing discouraged medical procedures, such the avoidance of venepuncture or blood pressure measurements on the at-risk extremity, on BCRL risk. This evidence has directly informed revisions to clinical practice guidelines and reshaped standards of care.
There remain critical research gaps in BCRL and lymphoedema of other aetiologies, including primary lymphoedema and lipoedema. Work is continuing in this regard, locally and internationally, to directly impact clinical practice and improve the standard of care for individuals at risk for or diagnosed with
lymphatic diseases.

Date of Award	28 May 2026
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	Joanna Wakefield-Scurr (Supervisor) & Edward St John (Supervisor)