When is it safe to administer injections in the arm on the same side as the breast cancer?

From the Guidelines

It is generally safe to administer injections in the arm on the same side as breast cancer after complete healing has occurred following surgery and when lymphedema is not present, typically at least 3-6 months post-treatment, as stated in the american cancer society/american society of clinical oncology breast cancer survivorship care guideline 1. When considering administering injections in the arm on the same side as breast cancer, several factors must be taken into account to minimize the risk of lymphedema.

• The risk of lymphedema is much lower with sentinel lymph node dissections than with the full axillary lymph node dissection, as noted in the guideline 1.
• Radiation treatment may cause or exacerbate lymphedema, especially radiation to the supraclavicular lymph nodes or axilla, which should be considered when deciding on injection sites.
• Obesity is also a risk factor for lymphedema, so physicians should recommend weight loss for those who are overweight or obese and emphasize the importance of maintaining a normal weight, as suggested in the guideline 1. However, whenever possible, it's preferable to use the arm opposite to the side affected by breast cancer, especially if the patient has undergone axillary lymph node dissection or radiation therapy.
• This precaution helps minimize the risk of lymphedema, a condition where fluid builds up in the arm due to compromised lymphatic drainage. For patients who have had bilateral breast cancer or have no alternative injection sites, the healthcare provider should assess the risks individually and may use the affected arm if necessary, but with careful technique using the smallest gauge needle possible and applying minimal pressure afterward.
• The concern stems from the fact that injections can introduce bacteria and cause inflammation, potentially overwhelming an already compromised lymphatic system in the affected arm. If you must receive an injection in the affected arm, inform your healthcare provider about your breast cancer history so they can take appropriate precautions, as the guideline suggests that more studies are needed in the area of lymphedema prevention above and beyond biopsy types and surgical strategies 1.

From the Research

Safety of Administering Injections in the Arm on the Same Side as Breast Cancer

• The safety of administering injections in the arm on the same side as breast cancer is a concern due to the risk of triggering lymphoedema, particularly in patients who have undergone axillary node removal 2, 3.
• Standard advice given to patients following axillary node removal is to avoid any injection or blood pressure measurement on the ipsilateral arm, although the evidence base in this area is severely lacking 2.
• A study found that out of 14 patients who underwent non-accidental skin puncture (NASP) procedures in the at-risk arm, no patients reported swelling to that limb within a month of these procedures 2.
• Another study investigated the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer, and found that most reported complications were minor, with only one patient experiencing infection and subsequent arm swelling 3.
• The study suggests that if a blood sample is taken or intravenous injection is given according to current guidelines, there should be a very low risk of complications 3.

Risk Factors for Lymphoedema

• Arm lymphoedema develops in 10%-35% of patients who undergo axillary dissection and/or nodal radiation therapy for breast cancer, with risk factors including greater extent of axillary surgery, more positive axillary nodes, and use of nodal radiation 4.
• Lymphoedema that occurs in the first 18 months after surgery or radiation is described as acute lymphoedema, and can be managed with conservative measures such as elevation of the arm and mild compression 4.

Management of Lymphoedema

• Treatment strategies for lymphoedema include elevation, complete decongestive physiotherapy, pneumatic pumps, and, after failure of all other methods, surgery 4.
• The advent of sentinel lymph node biopsy as an alternative to axillary dissection may decrease the rate of lymphoedema 4.
• Accurate axillary staging can be achieved after neo-adjuvant therapy in initially node-positive patients using dual tracer lymphatic mapping, removal of three or more lymph nodes, and confirmation of excision of the previously biopsied and clipped lymph node 5.