Skip to main content

Advertisement

SpringerLink
Log in

A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Women with Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.

Methods

Telephone surveys were conducted among women (65–89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries.

Results

Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and in 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were removal of more than five lymph nodes [odds ratio (OR) 4.68–5.61, 95% confidence interval (CI) 1.36–19.74 for 6–15 nodes; OR 10.50, 95% CI 2.88–38.32 for >15 nodes] and presence of lymph node metastases (OR 1.98, 95% CI 1.21–3.24).

Conclusions

Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors had self-reported lymphedema. In this group of predominately community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Petrek JA, Pressman PI, Smith RA. Lymphedema: current issues in research and management. CA Cancer J Clin. 2000;50:292–307.

    Article  PubMed  CAS  Google Scholar 

  2. Sparaco A, Fentiman IS. Arm lymphoedema following breast cancer treatment. Int J Clin Pract. 2002;56:107–10.

    PubMed  CAS  Google Scholar 

  3. The Medical and Psychological Concerns of Cancer Survivors after Treatment. In: Hewitt ME, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in translation. 1st ed. Washington, D.C.: National Academies Press; 2006. p. 87–9.

  4. Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93:96–111.

    Article  PubMed  CAS  Google Scholar 

  5. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Br J Surg. 1986;73:580–4.

    Article  PubMed  CAS  Google Scholar 

  6. Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D. Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Res Treat. 2003;79:47–57.

    Article  PubMed  Google Scholar 

  7. Kiel KD, Rademacker AW. Early-stage breast cancer: arm edema after wide excision and breast irradiation. Radiology. 1996;198:279–83.

    PubMed  CAS  Google Scholar 

  8. 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(2):383–91.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. McCredie MR, Dite GS, Porter L, Maskiell J, Giles GG, Phillips KA, et al. Prevalence of self-reported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast. 2001;10:515–22.

    Article  PubMed  CAS  Google Scholar 

  11. Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10:405–11.

    Article  PubMed  Google Scholar 

  12. Neuner JM, Gilligan MA, Sparapani R, Laud PW, Haggstrom D, Nattinger AB. Decentralization of breast cancer surgery in the United States. Cancer. 2004;101:1323–9.

    Article  PubMed  Google Scholar 

  13. Nattinger AB, Laud PW, Sparapani RA, Zhang X, Neuner JM, Gilligan MA. Exploring the surgeon volume outcome relationship among women with breast cancer. Arch Intern Med. 2007;167:1958–63.

    Article  PubMed  Google Scholar 

  14. Leitch AM, Meek AG, Smith RA, Boris M, Bourgeois P, Higgins S, et al. American Cancer Society Lymphedema Workshop Workgroup I: treatment of the axilla with surgery and radiation–preoperative and postoperative risk assessment. Cancer. 1998;83:2877–9.

    Article  PubMed  CAS  Google Scholar 

  15. Edge SB, Niland JC, Bookman MA, Theriault RL, Ottesen R, Lepisto E, et al. Emergence of sentinel node biopsy in breast cancer as standard-of-care in academic comprehensive cancer centers. J Natl Cancer Inst. 2003;95:1514–21.

    PubMed  Google Scholar 

  16. Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245:452–61.

    Article  PubMed  Google Scholar 

  17. Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007;25:3657–63.

    Article  PubMed  Google Scholar 

  18. Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM, et al. Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.

    Article  PubMed  Google Scholar 

  19. Nattinger AB, Laud PW, Bajorunaite R, Sparapani RA, Freeman JL. An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res. 2004;39:1733–49.

    Article  PubMed  Google Scholar 

  20. The North American Association of Central Cancer Registries, Inc. http://www.naaccr.org. Accessed 29 Sept 2008.

  21. Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20:4242–8.

    Article  PubMed  Google Scholar 

  22. Mandelblatt JS, Edge SB, Meropol NJ, Senie R, Tsangaris T, Grey L, et al. Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol. 2003;21:855–63.

    Article  PubMed  Google Scholar 

  23. Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer. 1998;83:2776–81.

    Article  PubMed  CAS  Google Scholar 

  24. Chagpar AB, Scoggins CR, Martin RC II, Carlson DJ, Laidley AL, El-Eid SE, et al. Are 3 sentinel nodes sufficient? Arch Surg. 2007;142:456–9 (discussion 9–60).

    Article  PubMed  Google Scholar 

  25. McCarter MD, Yeung H, Fey J, Borgen PI, Cody HS III. The breast cancer patient with multiple sentinel nodes: when to stop? J Am Coll Surg. 2001;192:692–7.

    Article  PubMed  CAS  Google Scholar 

  26. Zakaria S, Degnim AC, Kleer CG, Diehl KA, Cimmino VM, Chang AE, et al. Sentinel lymph node biopsy for breast cancer: how many nodes are enough?. J Surg Oncol. 2007;96:554–9.

    Article  PubMed  Google Scholar 

  27. Olson JA Jr, McCall LM, Beitsch P, Whitworth PW, Reintgen DS, Blumencranz PW, et al. Impact of immediate versus delayed axillary node dissection on surgical outcomes in breast cancer patients with positive sentinel nodes: results from American College of Surgeons Oncology Group Trials Z0010 and Z0011. J Clin Oncol. 2008;26:3530–5.

    Article  PubMed  Google Scholar 

  28. Nos C, Lesieur B, Clough KB, Lecuru F. Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection. Ann Surg Oncol. 2007;14:2490–6.

    Article  PubMed  Google Scholar 

  29. Thompson M, Korourian S, Henry-Tillman R, Adkins L, Mumford S, Westbrook KC, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol. 2007;14:1890–5.

    Article  PubMed  Google Scholar 

  30. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.

    Article  PubMed  CAS  Google Scholar 

  31. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.

    Article  PubMed  CAS  Google Scholar 

  32. Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52:370–9.

    Article  PubMed  Google Scholar 

  33. Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Maiterth C, et al. Long-term morbidity following axillary dissection in breast cancer patients–clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat. 2000;64:275–86.

    Article  PubMed  CAS  Google Scholar 

  34. Hack TF, Cohen L, Katz J, Robson LS, Goss P. Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol. 1999;17:143–9.

    PubMed  CAS  Google Scholar 

  35. Gerber LH. A review of measures of lymphedema. Cancer. 1998;83:2803–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This research was supported by Grant Numbers K07CA125586 (Dr. Yen) and R01CA81379 (Dr. Nattinger) from the National Institutes of Health/National Cancer Institute.

Author information

Authors and Affiliations

  1. Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Tina W. F. Yen MS, MD & Alonzo P. Walker MD

  2. Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA

    Tina W. F. Yen MS, MD, Xiaolin Fan PhD, Rodney Sparapani MS, Purushuttom W. Laud PhD & Ann B. Nattinger MPH, MD

  3. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    Xiaolin Fan PhD, Rodney Sparapani MS & Purushuttom W. Laud PhD

  4. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Ann B. Nattinger MPH, MD

Authors
  1. Tina W. F. Yen MS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaolin Fan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodney Sparapani MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Purushuttom W. Laud PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alonzo P. Walker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ann B. Nattinger MPH, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tina W. F. Yen MS, MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yen, T.W.F., Fan, X., Sparapani, R. et al. A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Women with Breast Cancer. Ann Surg Oncol 16, 979–988 (2009). https://doi.org/10.1245/s10434-009-0347-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0347-2

Keywords

Search

Navigation