b'Primary Lymphedema (Inherited orstudy conducted recently by researchers at Memorial Congenital) Sloan Kettering Cancer Center, the investigators Primary lymphedema is the rarer form of the diseaseobserved that Black and Hispanic women were roughly and, historically, has been subdivided into three1.5 to 2 times more likely to acquire lymphedema after categories: removal of the lymph nodes following breast cancer surgery. Studies like these, though limited in number, 1. Congenital lymphedema, present at birth orhelp the research and medical community define andrecognized early (within two years of birth), better understand the issues specific patient 2. L ymphedema praecox, presenting at puberty or populations may face and allow for better preparation up to the third decade of life, for those at risk for lymphedema.3. L ymphedema tarda, presenting after the age Why Are There Only Partial Treatmentsof 35 years. and No Cures for Lymphedema? Secondary Lymphedema (Caused by There is a historical lack of appreciation and support Injury or Trauma) for the lymphatic system and its interactions with Secondary lymphedema is more common than primarypathophysiologic processes. This deficiency begins at lymphedema, representing an estimated 99% ofthe level of doctoral medical education. A study presentations. Globally, the most common cause ofconducted in 2004 demonstrated that the majority of secondary lymphedema is filariasis, the consequenceU.S. medical students are exposed to approximately of a parasitic nematode infection. However, in30 minutes to 1 hour of lymphatic instruction during developed countries, the most common causes oftheir entire four years of training. As a result, secondary lymphedema are related to cancerrecognition of the lymphatic system in health and therapeutics (and occasionally the neoplasm itself),disease lags far behind our understanding of other adverse reactions to other therapeutics, chronichuman body systems. As an unfortunate consequence, venous disease (phlebolymphedema), and the adversehealthcare providers lack the training and awareness to effects of obesity 1 .identify a person who may be living with and suffering from lymphedema. Once a diagnosis is correctly made, What Is the Lymphatic System and it often has progressed to the point that treatment is Why Is it Important?not as effective as if it had been diagnosed in a timely The lymphatic system is one of eleven body systemsand efficient manner. responsible for maintaining health. It has several roles,As a result, epidemiologic evidence to quantify the including maintaining fluid balance in the body,subjective burden of this relative disease neglect is reacting to and dealing with foreign pathogensvirtually nonexistent. (bacteria, viruses, parasites, and fungi), gastrointestinalYet it is clear: A delay in diagnosis will lead to disease lipid absorption, and subserving immune surveillanceprogression, morbidity, and mortality.and antigen processing. Further, it is increasingly apparent that normal lymphatic function is involved inTherefore, educating our healthcare providers and the maintaining the healthy function of almost every organpublic is essential to mitigate the gap in access to system in the human body.healthcare and early diagnosis for people living with The Problem lymphedema. When the lymphatic system is altered, either by aFurther, early risk reduction of lymphedema has the primary, inherited disease or a secondary insult, suchcapacity to prevent ongoing suffering and the as trauma, infection, injury, venous insufficiency,psychological toll that runs parallel with the physical radiation, or surgery, the damage to lymphatic vesselsburden of the disease itself: results in outward physical signs and symptoms thatFeeling alone, isolated, not heard, and neglectedcan cause the swelling known as primary or secondaryHelplessness for both those living with lymphedemalymphedema, respectively.and the providers who are not equipped with the An estimated 10 million Americans are living withknowledge to diagnose or treat lymphedemalymphedema, and 1 in 3,000 children live with primaryDespair in learning that there are few effectivelymphedema. Lymphedema spares nobody: people oftreatments and no cures, even if a correct diagnosis all ages, sex, race, ethnicity, and socioeconomic statusis establishedare affected. More research is needed to betterPhysically enduring extreme fatigue and heaviness understand how social determinants of health andof the extremitiespopulation characteristics impact lymphedemaEnduring chronic pain, skin infections, cellulitis, and prevalence, incidence, and care. In a small cohortulcers resulting in repeated hospitalizations|National Indicator Report on Cancer-Related Lymphedema (LE)|4'