Risk Factors for Lymphedema after Breast Cancer Treatment

Abstract

Background: As cancer treatments evolve, it is important to reevaluate their effect on lymphedema risk in breast cancer survivors.Methods: A population-based random sample of 631 women from metropolitan Philadelphia, Pennsylvania, diagnosed with incident breast cancer in 1999 to 2001, was followed for 5 years. Risk factor information was obtained by questionnaire and medical record review. Lymphedema was assessed with a validated questionnaire. Using Cox proportional hazards models, we estimated the relative incidence rates [hazard ratios (HR)] of lymphedema with standard adjusted multivariable analyses ignoring interactions, followed by models including clinically plausible treatment interactions.Results: Compared with no lymph node surgery, adjusted HRs for lymphedema were increased following axillary lymph node dissection [ALND; HR, 2.61; 95% confidence interval (95% CI), 1.77-3.84] but not sentinel lymph node biopsy (SLNB; HR, 1.04; 95% CI, 0.58-1.88). Risk was not increased following irradiation [breast/ chest wall only: HR, 1.18 (95% CI, 0.80-1.73); breast/chest wall plus supraclavicular field (+/− full axilla): HR, 0.86 (95% CI, 0.48-1.54)]. Eighty-one percent of chemotherapy was anthracycline based. The HR for anthracycline chemotherapy versus no chemotherapy was 1.46 (95% CI, 1.04-2.04), persisting after stratifying on stage at diagnosis or number of positive nodes. Treatment combinations involving ALND or chemotherapy resulted in approximately 4-to 5-fold increases in HRs for lymphedema [e.g., HR of 4.16 (95% CI, for SLNB/chemotherapy/no radiation] compared with no treatment.Conclusion: With standard multivariable analyses, ALND and chemotherapy increased lymphedema risk whereas radiation therapy and SLNB did not. However, risk varied by combinations of exposures.Impact: Treatment patterns should be considered when counseling and monitoring patients for lymphedema.

A Cross-sectional Study Examining the Risk Factors Associated with Lymphedema and its Prevalence in Breast Cancer Patients after Level 3 Axillary Lymph Node Dissection

“…Chemotherapy has also been determined to be a significant risk factor for the development of lymphedema (12,23,26,27). In a study investigating the cosmetic results of breast cancer treatment, the patient group who underwent adjuvant chemotherapy was determined to have far more complications (26).…”

“…Similarly, our findings revealed that chemotherapy was a significant risk factor. The exact mechanism is not known; however, one may speculate that those patients receiving chemotherapy may have received more aggressive treatment (27). There are also studies that have reported a lack of association between chemotherapy and lymphedema (1,23,28).…”

Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer

“…Well-defined risk factors for developing lymphedema include axillary lymph node dissection (ALND), [9][10][11][12][13][14][15] regional lymph node irradiation (RLNR), 8,[16][17][18][19] higher body mass index (BMI), and older age at diagnosis. 7,8,11,14,[20][21][22][23][24][25][26][27][28][29][30] It remains unclear why, among patients with similar demographic and treatment-related characteristics, some go on to develop lymphedema.…”

Patient compliance with a health care provider referral for an occupational therapy lymphedema consult

“…The number of lymph nodes removed was the only participant characteristic shown to have a statistically significant difference between attenders and non-attenders. Numerous research studies have concluded that lymph node removal is a key risk factor for developing breast cancer-related lymphedema [3,[17][18][19][20][21][22]. Since nonattenders had fewer lymph nodes removed, one may posit that a reason for their lack of compliance was that they did not feel they were at risk for lymphedema or in need of an OT lymphedema consult.…”