Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema

Abstract

BackgroundLymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy.MethodsUsing the New York Statewide Planning and Research Cooperative System multicenter deidentified database from 2010 to 2016, a total of 65,543 breast cancer postmastectomy female patients (mean age, 59 ± 20 years) were identified across 177 facilities. The breast cancer patients were followed for any 2-year postmastectomy lymphedema-related events. A multivariable model identified predictors of 2-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on International Classification of Diseases codes used in hospital settings.ResultsOverall, 5.2% (n = 3409) of the breast cancer postmastectomy patients experienced a lymphedema-related event within 2 years of initial surgery. Over time, 2-year postmastectomy lymphedema rates have more than doubled from 4.62% in 2010 to 9.75% in 2016 (P < 0.001). Two-year postmastectomy lymphedema rates varied significantly by mastectomy procedure type: 5.69% of the mastectomy-only procedures, 5.96% of the mastectomies with lymph node biopsies, and 7.83% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared with partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors for a lymphedema-related event included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P's < 0.01).ConclusionsAlthough more recent postmastectomy lymphedema rates may not be as high as historical estimates, the 2-year postmastectomy lymphedema rates have more than doubled from 2010 to 2016 requiring further elucidation as well as continued focus on treatment. Furthermore, risk factors were identified that predispose postmastectomy breast cancer patients to developing lymphedema. Given these findings, perioperative screening seems warranted to proactively identify, educate, and monitor postmastectomy patients at greatest risk of future lymphedema development.

Postmastectomy Functional Impairments

“…A recent retrospective analysis identified several key risk factors for lymphedema-related events occurring within two years after mastectomy. These factors include higher comorbidity levels at baseline, longer hospitalization duration, more recent mastectomy procedures, higher BMI, younger age, non-Asian race, and hypertension [ 36 ]. Both SLNB and ALND are linked to an increased risk of lymphedema, with around 5% of SLNB recipients and up to 50% of ALND patients experiencing this condition [ 36 ].…”

“…These factors include higher comorbidity levels at baseline, longer hospitalization duration, more recent mastectomy procedures, higher BMI, younger age, non-Asian race, and hypertension [ 36 ]. Both SLNB and ALND are linked to an increased risk of lymphedema, with around 5% of SLNB recipients and up to 50% of ALND patients experiencing this condition [ 36 ]. Furthermore, regional lymph node radiation has been extensively documented as a major risk factor for the development of lymphedema [ 35 , 36 ].…”

Letter to the Editor: Comment on Kuruvilla AS, et al. Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: Amulticenter Retrospective Analysis. (Ann Plast Surg. 2022;88(3 suppl 3):S239–S245)

“…I read with great interest the article by Kuruvilla et al, 1 in which they evaluated the risk factors predictive of lymphedema-related events within 2 years of mastectomy in breast cancer patients. The predictive risk factors included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P < 0.01).…”

“…The 5-year survival rate for breast cancer is approximately 90% and up to 40% of women who receive breast cancer treatment develop lymphedema. 1 The goal for this population is to improve quality of life by offering treatment options for BCRL.…”

Invited Commentary from the Authors of: Kuruvilla AS, et al. Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: Amulticenter Retrospective Analysis

“…Limited data have been described in the literature regarding the risk factors associated with its development. Some of these factors are related to obesity, younger age, non-Asian race, Medicaid insurance, hypertension, higher surgical comorbidity index Elixhauser score, and greater hospitalization days 2 . In addition to these factors, chemotherapeutics and radiation therapy and their association with postmastectomy breast cancer–related lymphedema adverse events have been studied.…”