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Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women

Abstract

Purpose Lymphedema of the arm is a potential complication of breast cancer therapy. This study examines pre-disposing factors that may operate in conjunction with treatment-related factors in the development of arm lymphedema in a large cohort of White and Black breast cancer survivors. Methods 494 women (271 White and 223 Black) with in situ to Stage III-A primary breast cancer completed a baseline interview within 18 months of diagnosis. Information on lymphedema was collected during a follow-up interview, conducted on average 50 months after diagnosis. Self-reported data were used to classify women with or without lymphedema. Multivariable logistic regression models were developed to identify risk factors for arm lymphedema. Results Arm lymphedema was associated with younger age at diagnosis (odds ratio, OR per year of age = 0.96; 95% confidence interval, CI = 0.93–0.99), positive history of hypertension (OR = 2.31; 95% CI = 1.38–3.88), obesity (OR for body mass index, BMI≥30 = 2.48; 95% CI = 1.05–5.84) and having had surgery where 10 or more lymph nodes were excised (OR = 2.16; 95% CI = 1.12–4.17). While Black women had higher prevalence of arm lymphedema than White women (28% vs. 21%), race was not associated with lymphedema risk in models adjusted for multiple factors (adjusted OR = 1.01; 95% CI = 0.63–1.63). Conclusion Risk of arm lymphedema did not differ significantly for Black and White women. Risk factors identified in this study offer opportunities for interventions (weight loss, control of blood pressure, use of sentinel node biopsy where possible) for reducing incidence of lymphedema or controlling the symptoms associated with this condition.

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Acknowledgements

This project has been supported with funds from the National Institutes of Health: National Cancer Institute Contract No. N01-PC-35139 for the Los Angeles HEAL Study, National Cancer Institute grant CA 116848 for the USC Center for Transdisciplinary Research on Energetics and Cancer and National Institute of Child Health and Human Development Contract N01 HD 3-3175 for the Women’s CARE Study. A STOP CANCER Career Development Award also supports Dr. Meeske. The collection of California cancer incidence data providing the patient base for this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. The ideas and opinions expressed herein are those of the authors, and no endorsement by the State of California, Department of Health Services is intended or should be inferred.

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Correspondence to Leslie Bernstein.

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Meeske, K.A., Sullivan-Halley, J., Smith, A.W. et al. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat 113, 383–391 (2009). https://doi.org/10.1007/s10549-008-9940-5

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Keywords

  • Breast cancer survivors
  • Black breast cancer survivors
  • Arm lymphedema
  • Risk factors for arm lymphedema
  • Hypertension
  • Body mass index
  • Race