A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Women with Breast Cancer
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We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.
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.
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).
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.
- Petrek JA, Pressman PI, Smith RA. Lymphedema: current issues in research and management. CA Cancer J Clin. 2000;50:292–307. CrossRef
- Sparaco A, Fentiman IS. Arm lymphoedema following breast cancer treatment. Int J Clin Pract. 2002;56:107–10.
- 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.
- 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
- 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. CrossRef
- 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. CrossRef
- Kiel KD, Rademacker AW. Early-stage breast cancer: arm edema after wide excision and breast irradiation. Radiology. 1996;198:279–83.
- 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. 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
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- The North American Association of Central Cancer Registries, Inc. http://www.naaccr.org. Accessed 29 Sept 2008.
- 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. CrossRef
- 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. CrossRef
- Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer. 1998;83:2776–81. CrossRef
- 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). CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51. CrossRef
- 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. CrossRef
- Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52:370–9. CrossRef
- 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. CrossRef
- 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.
- Gerber LH. A review of measures of lymphedema. Cancer. 1998;83:2803–4. CrossRef
- A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Women with Breast Cancer
Annals of Surgical Oncology
Volume 16, Issue 4 , pp 979-988
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- 1. Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
- 2. Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA
- 3. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
- 4. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA