A prospective study of breast lymphedema: frequency, symptoms, and quality of life

Abstract

Purpose Although lymphedema of the arm is a well-known complication of breast and axillary surgery, breast lymphedema has received scant attention. We sought to prospectively characterize breast lymphedema’s incidence, associated symptoms, clinical course, and impact on quality of life. Methods Subjects were enrolled prospectively from a consecutive sample of patients undergoing non-mastectomy breast procedures (excisional biopsy or wide local excision ± lymph node removal) and followed for signs and symptoms of lymphedema in the operated breast. Symptoms and distress were serially assessed with 11-point linear analogue scales. Breast lymphedema was diagnosed independent of symptoms, based on the distribution and degree of edema and erythema. Results One hundred twenty-four women were followed for a median of 11 months, and breast lymphedema was diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast surgery with axillary node removal (49%) compared to breast surgery alone (0%), p<0.0001. Breast lymphedema involved multiple quadrants in most women and was characterized by edema in 100% and erythema in 79%. Patients with breast lymphedema were significantly more likely than women without breast lymphedema to report symptoms of breast heaviness (65% vs 22%, p<0.0001), redness (62% vs 29%, p=0.0006), and swelling (59% vs 22%, p<0.0001), but symptom-associated distress was low overall. Three of 32 breast lymphedema patients with clinical follow-up developed chronic edema. Conclusions Breast lymphedema occurs in approximately one-half of women who undergo breast surgery with axillary node removal. The condition is characterized by diffuse skin edema and erythema as well as self-reported symptoms with a low level of distress.

Psychometric properties of the Breast Cancer and Lymphedema Symptom Experience Index: The Chinese version

“…With increased rate and length of survival from breast cancer (Walters et al, 2013), managing late and chronic adverse effects from cancer treatment, such as lymphedema, is imperative to ensure quality of life among women treated for breast cancer. Breast cancer-related lymphedema (hereafter, lymphedema) or accumulation of lymph fluid is one such late and chronic adverse effect from breast cancer treatment (Degnim et al, 2012;Fu et al, 2013a. Lymphedema is a result of obstruction or disruption of the lymphatic system associated with cancer treatment, such as removal of lymph nodes or radiotherapy (Fu, 2014).…”

“…Patient personal factors also increase the risk of lymphedema, such as obesity or higher body mass index (BMI). Lymphedema negatively impacts breast cancer survivors' quality of life (Fu et al, 2013b;Park et al, 2012), especially physical experience of uncomfortable symptoms related to lymphedema (Degnim et al, 2012;Sierla et al, 2013).…”

“…Symptoms related to lymphedema remain the most distressing and debilitating late complications that elicit negative impact on the breast cancer survivors' quality of life (Degnim et al, 2012;Fu et al, 2013b;Sierla et al, 2013). Such symptoms include swelling, pain, tenderness, soreness, aching, heaviness, tightness, firmness, numbness, fatigue, stiffness, weakness and impaired limb mobility (Armer et al, 2003;Fu et al, 2013a;Fu and Rosedele, 2009).…”

Risk Factors Associated with Breast Lymphedema

“…4 In a prospective study evaluating the incidence of BLE, our group demonstrated that 31% of women undergoing breast surgery develop BLE.…”

“…The majority of patients and physicians, when thinking about lymphedema related to breast cancer treatment, consider lymphedema of the arm; 1 however, breast cancer patients can develop lymphedema in other regions including the chest wall and the breast. 2–4 Breast lymphedema (BLE) has not received as much attention by physicians and patients and has been understudied as it has been more challenging to quantify. Patients who undergo any breast surgery, in particular, those undergoing breast-conservation surgery for breast cancer, are at a theoretically increased risk of developing BLE due to the surgical incision and tissue dissection with potential disruption of lymphatic drainage of the breast.…”