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Risk Factors for Breast Cancer-Related Lymphedema: An Umbrella Review

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

Abstract

Background

Identification of risk factors facilitates the prevention of breast cancer-related lymphedema (BCRL). Several published systematic reviews have already addressed the risk factors for BCRL. This study aimed to systematically identify potential risk factors for BCRL and evaluate the quality of evidence.

Methods

The study followed methodologic guidance from the Joanna Briggs Institute, and the Cochrane Handbook. The following electronic databases were systematically searched from inception to 15 November 2022: PubMed, Embase, CINAHL, Web of Science, Scopus, CNKI, SinoMed, Wanfang, JBI Database, Cochrane Database, ProQuest, and PROSPERO. Two authors independently screened studies, extracted data, and assessed methodologic quality using AMSTAR2, risk of bias using ROBIS, and evidence quality using GRADE. The study evaluated overlap, assessed the small-study effect, and calculated the I2 statistic and Egger’s P value as needed.

Results

The study included 14 publications comprising 10 meta-analyses and 4 systematic reviews. The authors identified 39 factors and 30 unique meta-analyses. In the study, 13 innate personal trait-related risk factors, such as higher body mass index (BMI) and axillary lymph nodes dissection, showed statistically significant associations with BCRL incidence. Breast reconstruction was found to be a protective factor. The methodologic quality was low or critically low. The majority of the systematic reviews and/or meta-analyses were rated as having a high risk of bias. Evidence quality was low for 22 associations and moderate for 8 associations.

Conclusions

The currently identified risk factors for BCRL all are innate personal trait-related factors. Future well-designed studies and robust meta-analyses are needed to explore potential associations between behavioral-, interpersonal-, and environmental-related factors and BCRL, as well as the role of genetic variations and pathophysiologic factors.

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Acknowledgments

This umbrella review was supported by the National Natural Science Foundation of China (72174011).

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Authors and Affiliations

  1. Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    Aomei Shen MS, Wanmin Qiang BS, Liyuan Zhang BS & Jingru Bian BS

  2. Division of Medical and Surgical Nursing, School of Nursing, Peking University, Beijing, China

    Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD

  3. Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China

    Aomei Shen MS, Zijuan Zhang BS & Qian Lu PhD

  4. School of Nursing, Hebei University, Baoding, China

    Fei Zhu MS

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Correspondence to Qian Lu PhD.

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Shen, A., Qiang, W., Zhang, L. et al. Risk Factors for Breast Cancer-Related Lymphedema: An Umbrella Review. Ann Surg Oncol 31, 284–302 (2024). https://doi.org/10.1245/s10434-023-14277-7

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