More than half of the women who undergo breast-conserving surgery for breast cancer and receive radiotherapy afterwards report breast symptoms —pain, hardness, oversensitivity or swelling— at least twice a week. An Australian study compares four questionnaires for so-called breast lymphoedema and concludes that BLYSS measures it best.
What was known
Breast lymphoedema —swelling and changes in the consistency of breast tissue— may appear after breast-conserving surgery and radiotherapy. Several questionnaires exist to quantify these symptoms from the patient’s point of view, but evidence on their measurement properties (reliability, validity, ability to detect change) was limited, making it hard to choose on a reasoned basis.
What this work adds
The authors recruited women who had undergone breast-conserving surgery and received radiotherapy, and administered four questionnaires —the Breast Lymphoedema Severity Symptom questionnaire (BLYSS), the EORTC Quality of Life Questionnaire – Breast Symptom Subscale (EORTC-QLQ-BSS), the Lymphoedema Symptom Intensity and Distress scale-Trunk (LSIDS-T) and the Breast Oedema Bother scale (BOB)— three and nine months after radiotherapy. In total, 164 women responded at the first assessment and 152 at the second. Internal consistency, construct validity, factor structure and responsiveness were analysed.
Main results
Internal consistency was strong for all four instruments (McDonald’s omega and Cronbach’s alpha of 0.7 or above). The correlation of BLYSS with EORTC-QLQ-BSS and with the BOB visual analogue scale reached the hypothesised level (Spearman correlation of 0.7 or above), supporting construct validity. Factor analysis identified a single factor for each individual tool and four when all four were combined: pain, swelling, breast sensations and hardness. Responsiveness was high for BLYSS and moderate for the other two. More than half of the women had symptoms at least twice a week, of mild to extreme severity; the most frequent were pain, hardness, oversensitivity and swelling.
What it means
Persistent breast symptoms are common after breast-conserving treatment and radiotherapy, and they often fall outside the focus of the oncology consultation, which is more attuned to the contralateral breast or systemic toxicity. A questionnaire with solid properties makes it possible to detect them systematically and comparably, and to assess whether an intervention —physiotherapy, skin care, a better-fitting bra— improves what the patient feels. The study does not compare treatments: its contribution is methodological.
Reading from the breast unit
For a breast unit, these symptoms can be recorded with a short, scorable instrument at the three- and nine-month review after radiotherapy, and referred to rehabilitation when appropriate, without relying on the patient raising them.
Reference: Fearn N, Kilbreath S, Dylke E, Wang W, Llanos C, Ahern V, et al. Comparison of four breast lymphoedema patient reported outcome measures in women following breast conserving surgery and radiotherapy: examination of frequencies of symptoms and measurement properties. Breast Cancer, 2026. DOI
