Risk factors associated with breast cancer-related lymphedema in the WHEL Study
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Lymphedema is a significant health problem faced by a large percentage of breast cancer survivors. The Women’s Healthy Eating and Living (WHEL) Study has a unique dataset collected after the completion of breast cancer treatment, which allowed a focused analysis of risk factors for breast cancer-related lymphedema.
Participant characteristics, treatment modalities, and health behaviors were examined as potential predictors of lymphedema among breast cancer survivors with univariate analyses and multivariate logistic regression.
Lymphedema status was assessed for 83 % of the study cohort (2,431 of the 2,917 WHEL participants). Among these respondents, 692 (28.5 %) women reported yes to either a physician’s diagnosis of lymphedema or a question on arm/hand swelling. When compared to other participants, women with lymphedema were diagnosed at a younger age, more likely to have a higher body mass index, had a larger tumor size, had more lymph nodes removed, more likely to have a mastectomy with radiation therapy, and more likely to have chemotherapy. In the final multivariate-adjusted model, body mass index greater than 25 kg/m2 (p < 0.01), the removal of 11 or more lymph nodes (p < 0.01), and breast cancer surgery plus radiation therapy (p < 0.01) showed a strong independent association with developing breast cancer-related lymphedema.
The results of this study highlight the importance of educating breast cancer survivors about the modifiable risk factors (e.g., body mass index) associated with the development of lymphedema.
Implications for Cancer Survivors
Breast cancer survivors at risk for lymphedema may benefit from interventions aimed at achieving or maintaining a healthy body weight.
- Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Waldron W, et al. SEER cancer statistics review, 1975–2008. Bethesda, MD: National Cancer Institute; 2011.
- Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer. 1998;83:2776–81. CrossRef
- Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93:96–111. CrossRef
- Shih Y-CT XY, Cormier JN, Giordano S, Ridner SH, Buchholz TA, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27:2007–14. CrossRef
- Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4:167–78. CrossRef
- Ahmed RL, Schmitz KH, Prizment AE, Folsom AR. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res Treat. 2011;130:981–91. CrossRef
- Yen TWF, Fan X, Sparapani R, Laud PW, Walker AP, Nattinger AB. A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol. 2009;16:979–88. CrossRef
- McLaughlin SA, Wright MJ, Morris KT, Sampson MR, Brockway JP, Hurley KE, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol. 2008;26:5220–6. CrossRef
- Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ. Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol. 2010;17:3278–86. CrossRef
- Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2007;16:775–82. CrossRef
- Ridner SH, Dietrich MS, Stewart BR, Armer JM. Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer. 2011;19:853–7. CrossRef
- Sakorafas GH, Peros G, Cataliotti L, Vlastos G. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol. 2006;15:153–65. CrossRef
- Norman SA, Localio AR, Kallan MJ, Weber AL, Torpey HAS, Potashnik SL, et al. Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev. 2010;19:2734–46. CrossRef
- Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways study. Arch Surg. 2010;145:1055–63. CrossRef
- Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, et al. Risk factors for arm lymphedema following breast cancer diagnosis in black women and white women. Breast Cancer Res Treat. 2009;113:383–91. CrossRef
- Pierce JP, Faerber S, Wright FA, Rock CL, Newman VA, Flatt SW, et al. A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) study. Control Clin Trials. 2002;23:728–56. CrossRef
- Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007;298:289–98. CrossRef
- Johnson-Kozlow M, Rock CL, Gilpin EA, Hollenbach KA, Pierce JP. Validation of the WHI brief physical activity questionnaire among women diagnosed with breast cancer. Am J Health Behav. 2007;31:193–202. CrossRef
- Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504. CrossRef
- Hong S, Bardwell WA, Natarajan L, Flatt SW, Rock CL, Newman VA, et al. Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) study. Breast Cancer Res Treat. 2007;101:225–32. CrossRef
- Bertram LAC, Stefanick ML, Saquib N, Natarajan L, Patterson RE, Bardwell W, et al. Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL study. Cancer Causes Control. 2011;22:427–35. CrossRef
- Norman SA, Miller LT, Erikson HB, Norman MF, McCorkle R. Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer. Phys Ther. 2001;81:1192–205.
- Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26:3536–42. CrossRef
- Ridner SH, Dietrich MS. Self-reported comorbid conditions and medication usage in breast cancer survivors with and without lymphedema. Oncol Nurs Forum. 2008;35:57–63. CrossRef
- Risk factors associated with breast cancer-related lymphedema in the WHEL Study
Journal of Cancer Survivorship
Volume 7, Issue 1 , pp 115-123
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Breast cancer survivors
- Risk factors
- Body mass index
- Lymph node removal
- Breast cancer treatment
- Industry Sectors
- Author Affiliations
- 1. Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
- 2. Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093-0901, USA