For Breast Cancer Survivors, Curling Iron is a Key Preventive Tactic 

After her breast cancer surgery, Tia struggled with mobility in her left shoulder. It felt as though the joint was frozen, and she could feel some swelling in her chest. After several dead ends, she learned that this feeling may be caused by early-stage lymphedema. 

This condition is a common side effect of breast cancer operations in which underarm lymph nodes are removed. Taking those nodes out of the equation is akin to cutting off a highway intersection resulting in buildup of lymph fluid.  

Although it waxes and wanes, the resulting swelling is uncomfortable and may affect the shoulders, arms, and chest. Even more concerning: It may predispose someone to infection and influence their mobility. 

Jennifer Ligibel, MD, a Dana-Farber breast oncologist who specializes in exercise research, notes that there may be psychological effects associated with lymphedema as well. For people who have made it through breast cancer treatment, the swelling, and some of the typical interventions like compression sleeves, are a reminder or a mark of the disease they survived. 

Tia had been given a compression bra but wanted to explore every option available to prevent lymphedema.  In addition to her discomfort, she was concerned about her posture. “I’m five foot four and I don’t want to seem any shorter,” she explains. To find out how she could navigate these concerns, she visited Nancy Campbell, MS, a clinical exercise physiologist at Dana-Farber’s Leonard P. Zakim Center for Integrative Therapies.  

Had Tia sought care for this two decades ago, most physicians would have recommended moving as little as possible. Noting an onset of lymphedema after an inciting event like raking leaves or shoveling snow, these physicians believed that strenuous movement led to lymphedema.  

“We used to tell people to never lift more than five pounds,” Ligibel says. “It was probably the worst advice you could give.” 

She explains that this theory did not recognize the importance of regular exercise to keep muscles conditioned. “It became a kind of folklore,” she recalls, related to other theories which were ultimately not found to be true – such as the need to preventatively wear compression sleeves on airplanes for patients who did not have lymphedema. 

This changed in 2009 when a study led by University of Pittsburgh’s Kathryn Schmitz, PhD, MPH, compared a group of patients that underwent an exercise regimen to another that did not. A supervised weightlifting program, it was found, could prevent and even reduce the problems associated with lymphedema, as it improves muscle tone and helps lymph fluid move appropriately. In the years since, several other studies have bolstered this conclusion.  Exercise was found to also lower risk factors for lymphedema like obesity and inflammation. 

Dana-Farber was quick to adjust its programs to reflect the change, introducing strength training and yoga programs specifically for lymphedema prevention in the Zakim Center. Patients who are interested in this kind of intervention should speak with a physician to ensure that it is safe. 

“The training needs to be structured,” Ligibel warns. “Weight should be increased slowly, and every patient should speak with their physician before starting an exercise regimen.” 

Growing up in Boston and then living in New York City for a time, Tia was a lifetime walker before her treatment and was always diligent about eating well, but her meeting with Campbell was the first time she encountered weightlifting. During a consultation, Campbell outlined a regimen that would avoid injury and bolster strength over time. 

“I started it with no expectations of a benefit at all,” she says.  

Now she lifts at home three times a week and supplements that with Qigong and Tai chi through the Zakim Center. 

“I love doing it,” Tia says. “I feel stronger. The more I move, the better I feel.” 

All of it allows her to lead the active lifestyle she wants: Walking the dog, tending her vegetable garden, and keeping up with her kids. It also offers mental and emotional support when she feels stressed. 

She sums it up quite simply: “It has changed my life.” 

About the Medical Reviewer

Dr. Jennifer Ligibel is a Professor at Harvard Medical School and a Senior Physician in the Breast Oncology Center at the Dana-Farber Cancer Institute. Dr. Ligibel’s research focuses on the impact of energy balance factors, such as physical activity and body weight, upon cancer risk and outcomes. She has conducted more than a dozen randomized trials evaluating the impact of exercise and weight loss interventions on endpoints such as cardiorespiratory fitness, biomarkers associated with cancer risk and outcomes, body composition, and quality of life in cancer patients and survivors. This work has culminated in the design and implementation of the Breast Cancer Weight Loss (BWEL) Trial, the only fully powered Phase III clinical trial designed to test the impact of a weight loss intervention on invasive disease-free survival in women with early-stage breast cancer and obesity (NCT02750826). 

In addition to primary research work, Dr. Ligibel also is the Director of the Leonard P. Zakim Center for Integrative Therapies and Healthy Living and has built a comprehensive clinical Healthy Living Program for patients at Dana-Farber and beyond that offers an array of exercise classes, nutrition seminars, cooking demonstrations, programs focused on healthy cooking for families, weight management programs, and holistic longitudinal programs to foster wellness during and after cancer treatment. 

Finally, Dr. Ligibel is the inaugural Director of Center for Faculty Well-Being at Dana-Farber. In this role, she studies the prevalence and predictors of burnout in academic physicians, as well as develops solutions to mitigate and prevent burnout in Dana-Farber Faculty. In recognition of her work in mentoring and supporting faculty, she was awarded the Hologic, Inc Endowed Women Who Conquer Cancer Mentorship Award in 2021.