Supportive Care in Cancer

, Volume 21, Issue 7, pp 2017–2024 | Cite as

Lymphedema: experience of a cohort of women with breast cancer followed for 4 years after diagnosis in Victoria, Australia

  • Robin J. Bell
  • Penelope J. Robinson
  • Raychel Barallon
  • Pamela Fradkin
  • Max Schwarz
  • Susan R. Davis
Original Article



The aim of this work was to study the incidence and prevalence of self-reported lymphedema in breast cancer survivors between 2 and 4 years following diagnosis, the factors associated with the development of lymphedema and the impact of lymphedema on psychological well-being.


We assessed self-reported lymphedema in the BUPA Health Foundation Health and Wellbeing After Breast Cancer Study, a questionnaire-based study of 1,683 women newly diagnosed with their first episode of invasive breast cancer in Victoria, Australia. Psychological well-being was assessed using the Psychological General Well-being Index.


Two years after diagnosis, nearly 20 % of women reported lymphedema and this proportion remained above 18 % 2 years later. However, self-reported lymphedema was a dynamic phenomenon, with the condition resolving in some women and others reporting onset for the first time up to 4 years from diagnosis. Lymphedema 2 years from diagnosis was positively associated with the number of nodes removed at initial surgery, although this variable only explained a small proportion of the likelihood of reporting lymphedema. The presence of lymphedema was associated with lower psychological general well-being.


Lymphedema after breast cancer treatment frequently has a dynamic pattern and may emerge as an issue for women several years after their initial treatment. It is associated with a lower level of general well-being.


Lymphedema Breast cancer Prevalence Incidence Resolution Determinants 



The authors wish to thank the study participants and the members of our Study Advisory Group: Dr Jacquie Chirgwin, A/Professor John Collins, Professor Graham Giles, Mr Peter Gregory, Mr Stewart Hart, Ms Suzanne Neil and Mrs Avis McPhee. The authors also wish to thank the members of the research team of the Health and Wellbeing After Breast Cancer study, without whose hard work this large cohort study would not be possible (Maria La China and Jo Bradbury). Finally, we thank Ms Helen Farrugia, Director of Information Systems and Professor Graham Giles, Director, of the Victorian Cancer Registry, for their ongoing support of this study.

Funding sources

This work was supported by the BUPA Health Foundation (previously the Medical Benefits Fund of Australia Limited Foundation) (to SRD and RJB), the National Health and Medical Research Council of Australia (grant nos. 219279 to SRD and RJB, 490938 to SRD), Novartis Oncology Australia, the L.E.W. Carty Trust, the Jack and Robert Smorgon Families Foundation and Connie and Craig Kimberley and Roy Morgan Research (all to SRD and RJB). This research project was also supported by the Victorian Government through a Victorian Cancer Agency Research Fellowship (to RJB).

Conflict of interest

None of the authors consider that they have any conflict of interest that could inappropriately influence or bias this work. None of the funding agencies had any role in determining study design; in the collection, analysis and interpretation of data; and in the writing of the manuscript or in the decision to submit the manuscript for publication.

Ethical approval

The study is being carried out with the approval of the Ethics Committee of the Cancer Council of Victoria and the Human Ethics Committee of Monash University and all participants have provided written informed consent.


  1. 1.
    Szuba A, Rockson SG (1998) Lymphedema: classification, diagnosis and therapy. Vasc Med 3:145–156PubMedGoogle Scholar
  2. 2.
    Ridner SH (2005) Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13:904–911PubMedCrossRefGoogle Scholar
  3. 3.
    Passik SD, McDonald MV (1998) Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma. Cancer 83:2817–2820PubMedCrossRefGoogle Scholar
  4. 4.
    Francis WP, Abghari P, Du W, Rymal C, Suna M, Kosir MA (2006) Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection. Am J Surg 192:636–639PubMedCrossRefGoogle Scholar
  5. 5.
    National Breast and Ovarian Cancer Centre (2008) Review of research evidence on secondary lymphoedema: incidence, prevention, risk factors and treatment. National Breast and Ovarian Cancer Centre, SydneyGoogle Scholar
  6. 6.
    Armer JM, Stewart BR (2005) A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol 3:208–217PubMedCrossRefGoogle Scholar
  7. 7.
    Lijovic M, Davis SR, Fradkin P, La China M, Farrugia H, Wolfe R, Bell RJ (2008) Use of a cancer registry is preferable to a direct-to-community approach for recruitment to a cohort study of wellbeing in women newly diagnosed with invasive breast cancer. BMC Cancer 8:126PubMedCrossRefGoogle Scholar
  8. 8.
    Dupuy H (1984) The Psychological General Well-Being (PGWB) Index. In: Wenger N, Mattson M, Furburg C, Elinson J (eds) Assessment of quality of life in clinical trials of cardiovascular therapies. Le Jacq Publishing, New York, pp 170–183Google Scholar
  9. 9.
    Bell RJ, Lijovic M, La China M, Schwarz M, Fradkin P, Bradbury J, Davis SR (2010) Psychological well-being in a cohort of women with invasive breast cancer nearly 2 years after diagnosis. Support Care Cancer 18:921–929PubMedCrossRefGoogle Scholar
  10. 10.
    Bell RJ, Donath S, Davison SL, Davis SR (2006) Endogenous androgen levels and well-being: differences between premenopausal and postmenopausal women. Menopause 13:65–71PubMedCrossRefGoogle Scholar
  11. 11.
    Botlero R, Bell RJ, Urquhart DM, Davis SR (2010) Urinary incontinence is associated with lower psychological general well-being in community-dwelling women. Menopause 17:332–337PubMedCrossRefGoogle Scholar
  12. 12.
    Urquhart DM, Shortreed S, Davis SR, Cicuttini FM, Bell RJ (2009) Are low levels of low back pain intensity and disability associated with reduced well-being in community-based women. Climacteric 12:266–275PubMedCrossRefGoogle Scholar
  13. 13.
    Lee TS, Baumgart KW (2012) Vaccines and risk of lymphoedema—a case report of a breast cancer patient. Aust Fam Physician 41:404–406PubMedGoogle Scholar
  14. 14.
    Ronka R, von Smitten K, Tasmuth T, Leidenius M (2005) One-year morbidity after sentinel node biopsy and breast surgery. Breast 14:28–36PubMedCrossRefGoogle Scholar
  15. 15.
    Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE (2007) 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 25:3657–3663PubMedCrossRefGoogle Scholar
  16. 16.
    Petrek JA, Senie RT, Peters M, Rosen PP (2001) Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92:1368–1377PubMedCrossRefGoogle Scholar
  17. 17.
    Wilke LG, McCall LM, Posther KE, Whitworth PW, Reintgen DS, Leitch AM, Gabram SG, Lucci A, Cox CE, Hunt KK, Herndon JE 2nd, Giuliano AE (2006) Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol 13:491–500PubMedCrossRefGoogle Scholar
  18. 18.
    Ahmed RL, Schmitz KH, Prizment AE, Folsom AR (2011) Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study. Breast Cancer Res Treat 130:981–991PubMedCrossRefGoogle Scholar
  19. 19.
    Norman SA, Localio AR, Potashnik SL, Simoes Torpey HA, Kallan MJ, Weber AL, Miller LT, Demichele A, Solin LJ (2009) Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms. J Clin Oncol 27:390–397PubMedCrossRefGoogle Scholar
  20. 20.
    Armer JM, Stewart BR, Shook RP (2009) 30-month post-breast cancer treatment lymphoedema. J Lymphoedema 4:14–18PubMedGoogle Scholar
  21. 21.
    Armer JM, Stewart BR (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43:118–127PubMedGoogle Scholar
  22. 22.
    Shah C, Vicini FA (2011) Breast cancer-related arm lymphedema: incidence rates, diagnostic techniques, optimal management and risk reduction strategies. Int J Radiat Oncol Biol Phys 81:907–914PubMedCrossRefGoogle Scholar
  23. 23.
    Hayes S, Cornish B, Newman B (2005) Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat 89:221–226PubMedCrossRefGoogle Scholar
  24. 24.
    Lopez Penha TR, Slangen JJ, Heuts EM, Voogd AC, Von Meyenfeldt MF (2011) Prevalence of lymphoedema more than five years after breast cancer treatment. Eur J Surg Oncol 37:1059–1063PubMedCrossRefGoogle Scholar
  25. 25.
    Australian Institute of Health and Welfare (2009) Breast cancer in Australia: an overview, 2009. Cat. no. CAN 46. AIHW, CanberraGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Robin J. Bell
    • 1
  • Penelope J. Robinson
    • 1
  • Raychel Barallon
    • 1
  • Pamela Fradkin
    • 1
  • Max Schwarz
    • 2
    • 3
  • Susan R. Davis
    • 1
  1. 1.Women’s Health Program, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Department of Medicine, Central Clinical SchoolMonash UniversityMelbourneAustralia
  3. 3.Alfred HealthMelbourneAustralia

Personalised recommendations