Skip to main content

Advertisement

SpringerLink
Log in

Impact of body mass index and weight fluctuation on lymphedema risk in patients treated for breast cancer

  • Clinical Trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Identifying risk factors for lymphedema in patients treated for breast cancer has become increasingly important, given the current lack of standardization surrounding diagnosis and treatment. Reports on the association of body mass index (BMI) and weight change with lymphedema risk are conflicting. We sought to examine the impact of pre-operative BMI and post-treatment weight change on the incidence of lymphedema. From 2005 to 2011, 787 newly diagnosed breast cancer patients underwent prospective arm volume measurements with a Perometer pre- and post-operatively. BMI was calculated from same-day weight and height measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10 %. Univariate and multivariate Cox proportional hazards models were used to evaluate the association between lymphedema risk and pre-operative BMI, weight change, and other demographic and treatment factors. By multivariate analysis, a pre-operative BMI ≥30 was significantly associated with an increased risk of lymphedema compared to a pre-operative BMI <25 and 25- <30 (p = 0.001 and p = 0.012, respectively). Patients with a pre-operative BMI 25- <30 were not at an increased risk of lymphedema compared to patients with a pre-operative BMI <25 (p = 0.409). Furthermore, a cumulative absolute weight fluctuation of 10 pounds gained/lost per month post-operatively significantly increased risk of lymphedema (HR: 1.97, p = < 0.0001). In conclusion, pre-operative BMI of ≥30 is an independent risk factor for lymphedema, whereas a BMI of 25- <30 is not. Large post-operative weight fluctuations also increase risk of lymphedema. Patients with a pre-operative BMI ≥30 and those who experience large weight fluctuations during and after treatment for breast cancer should be considered at higher-risk for lymphedema. Close monitoring or early intervention to ensure optimal treatment of the condition may be appropriate for these patients.

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

Fig. 1

Similar content being viewed by others

References

  1. Ahmed RL, Prizment A, Lazovich D, Schmitz KH, Folsom AR (2008) Lymphedema and quality of life in breast cancer survivors: the Iowa Women’s Health Study. J Clin Oncol 26(35):5689–5696. doi:10.1200/JCO.2008.16.4731

    Article  PubMed  Google Scholar 

  2. Hayes SC, Janda M, Cornish B, Battistutta D, Newman B (2008) Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol 26(21):3536–3542. doi:10.1200/JCO.2007.14.4899

    Article  PubMed  Google Scholar 

  3. Jager G, Doller W, Roth R (2006) Quality-of-life and body image impairments in patients with lymphedema. Lymphology 39(4):193–200

    PubMed  CAS  Google Scholar 

  4. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A (2009) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19(3):299–305. doi:10.1002/pon.1573

    Article  Google Scholar 

  5. Armer JM, Stewart BR (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43(3):118–127

    PubMed  CAS  Google Scholar 

  6. Disipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. doi:10.1016/S1470-2045(13)70076-7

    PubMed  Google Scholar 

  7. McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26(32):5213–5219. doi:10.1200/JCO.2008.16.3725

    Article  PubMed  Google Scholar 

  8. 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(3):981–991. doi:10.1007/s10549-011-1667-z

    Article  PubMed  Google Scholar 

  9. Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C (2009) The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 16(7):1959–1972. doi:10.1245/s10434-009-0452-2

    Article  PubMed  Google Scholar 

  10. Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, Perkins GH, Elting LS (2009) Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol 27(12):2007–2014. doi:10.1200/JCO.2008.18.3517

    Article  PubMed  Google Scholar 

  11. Norman SA, Localio AR, Kallan MJ, Weber AL, Torpey HA, Potashnik SL, Miller LT, Fox KR, DeMichele A, Solin LJ (2010) Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev 19(11):2734–2746. doi:1055-9965.EPI-09-1245

    Article  PubMed  Google Scholar 

  12. Park JH, Lee WH, Chung HS (2008) Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs 17(11):1450–1459. doi:10.1111/j.1365-2702.2007.02187.x

    Article  PubMed  Google Scholar 

  13. Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, Bernstein L (2009) Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat. doi:10.1007/s10549-008-9940-5

    PubMed  Google Scholar 

  14. Hayes SB, Freedman GM, Li T, Anderson PR, Ross E (2008) Does axillary boost increase lymphedema compared with supraclavicular radiation alone after breast conservation? Int J Radiat Oncol Biol Phys 72(5):1449–1455. doi:10.1016/j.ijrobp.2008.02.080

    Article  PubMed  Google Scholar 

  15. Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ (2010) Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol 17(12):3278–3286. doi:10.1245/s10434-010-1155-4

    Article  PubMed  Google Scholar 

  16. Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM (2007) The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev 16(4):775–782. doi:10.1158/1055-9965.EPI-06-0168

    Article  PubMed  Google Scholar 

  17. Querci della Rovere G, Ahmad I, Singh P, Ashley S, Daniels IR, Mortimer P (2003) An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle. Ann R Coll Surg Engl 85(3):158–161. doi:10.1308/003588403321661299

    Google Scholar 

  18. Crosby MA, Card A, Liu J, Lindstrom WA, Chang DW (2012) Immediate breast reconstruction and lymphedema incidence. Plast Reconstr Surg 129(5):789e–795e. doi:10.1097/PRS.0b013e31824a2ab1

    Article  PubMed  Google Scholar 

  19. Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G (2001) Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer 92(7):1783–1787. doi:10.1002/1097-0142(20011001)92:7<1783

    Article  PubMed  CAS  Google Scholar 

  20. Graham P, Jagavkar R, Browne L, Millar E (2006) Supraclavicular radiotherapy must be limited laterally by the coracoid to avoid significant adjuvant breast nodal radiotherapy lymphoedema risk. Australas Radiol 50(6):578–582. doi:10.1111/j.1440-1673.2006.01658.x

    Article  PubMed  CAS  Google Scholar 

  21. Coen JJ, Taghian AG, Kachnic LA, Assaad SI, Powell SN (2003) Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys 55(5):1209–1215. doi:10.1016/S0360-3016(02)04273-6

    Article  PubMed  Google Scholar 

  22. Cormier JN, Xing Y, Zaniletti I, Askew RL, Stewart BR, Armer JM (2009) Minimal limb volume change has a significant impact on breast cancer survivors. Lymphology 42(4):161–175

    PubMed  CAS  Google Scholar 

  23. Ridner SH, Dietrich MS, Stewart BR, Armer JM (2011) Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer 19(6):853–857. doi:10.1007/s00520-011-1089-9

    Article  PubMed  Google Scholar 

  24. Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH (2010) Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg 145(11):1055–1063. doi:10.1001/archsurg.2010.231

    Article  PubMed  Google Scholar 

  25. Helyer LK, Varnic M, Le LW, Leong W, McCready D (2010) Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J 16(1):48–54. doi:10.1111/j.1524-4741.2009.00855.x

    Article  PubMed  Google Scholar 

  26. Swenson KK, Nissen MJ, Leach JW, Post-White J (2009) Case-control study to evaluate predictors of lymphedema after breast cancer surgery. Oncol Nurs Forum 36(2):185–193. doi:10.1188/09.ONF.185-193

    Article  PubMed  Google Scholar 

  27. Vignes S, Arrault M, Dupuy A (2007) Factors associated with increased breast cancer-related lymphedema volume. Acta Oncol 46(8):1138–1142. doi:10.1080/02841860701403020

    Article  PubMed  Google Scholar 

  28. Soran A, D’Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H, Vogel VG, Johnson RR (2006) Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema? Breast J 12(6):536–543. doi:10.1111/j.1524-4741.2006.00342.x

    Article  PubMed  Google Scholar 

  29. Clark B, Sitzia J, Harlow W (2005) Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. Q J Med 98:343–348

    Article  CAS  Google Scholar 

  30. Petrek JA, Senie RT, Peters M, Rosen PP (2001) Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92(6):1368–1377. doi:10.1002/1097-0142(20010915)92:6<1368

    Article  PubMed  CAS  Google Scholar 

  31. Werner RS, McCormick B, Petrek J, Cox L, Cirrincione C, Gray JR, Yahalom J (1991) Arm edema in conservatively managed breast cancer: obesity is a major predictive factor. Radiology 180(1):177–184

    PubMed  CAS  Google Scholar 

  32. Ancukiewicz M, Russell TA, Otoole J, Specht M, Singer M, Kelada A, Murphy CD, Pogachar J, Gioioso V, Patel M, Skolny M, Smith BL, Taghian AG (2011) Standardized method for quantification of developing lymphedema in patients treated for breast cancer. Int J Radiat Oncol Biol Phys 79(5):1436–1443. doi:10.1016/j.ijrobp.2010.01.001

    Article  PubMed  Google Scholar 

  33. Ancukiewicz M, Miller CL, Skolny MN, O’Toole J, Warren LE, Jammallo LS, Specht MC, Taghian AG (2012) Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology. Breast Cancer Res Treat 135(1):145–152. doi:10.1007/s10549-012-2111-8

    Article  PubMed  Google Scholar 

  34. Armer JM, Stewart BR (2005) A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol 3(4):208–217. doi:10.1089/lrb.2005.3.208

    Article  PubMed  Google Scholar 

  35. Stanton AW, Northfield JW, Holroyd B, Mortimer PS, Levick JR (1997) Validation of an optoelectronic limb volumeter (Perometer). Lymphology 30(2):77–97

    PubMed  CAS  Google Scholar 

  36. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 112(12):2809–2819. doi:10.1002/cncr.23494

    Article  PubMed  Google Scholar 

  37. Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378. doi:10.1200/JCO.2005.01.079

    Article  PubMed  Google Scholar 

  38. Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer—effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132

    Article  PubMed  CAS  Google Scholar 

  39. Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, Blackwell K, Rimer BK (2001) Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 19(9):2381–2389

    PubMed  CAS  Google Scholar 

  40. Huntington MO (1985) Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer 56(3):472–474

    Article  PubMed  CAS  Google Scholar 

  41. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348(17):1625–1638. doi:10.1056/NEJMoa021423

    Article  PubMed  Google Scholar 

  42. Enger SM, Greif JM, Polikoff J, Press M (2004) Body weight correlates with mortality in early-stage breast cancer. Arch Surg 139(9):954–958. doi:10.1001/archsurg.139.9.954 discussion 958–960

    Article  PubMed  Google Scholar 

  43. Shaw C, Mortimer P, Judd PA (2007) A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer 110(8):1868–1874. doi:10.1002/cncr.22994

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The project described was supported by Award Number R01CA139118 (AGT), Award Number P50CA089393 (AGT) from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Lauren S. Jammallo, Cynthia L. Miller, Melissa N. Skolny & Alphonse G. Taghian

  2. Cancer Center, Tufts Medical Center, Boston, MA, USA

    Marybeth Singer

  3. Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

    Nora K. Horick

  4. Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Michelle C. Specht

  5. Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA

    Jean O’Toole

Authors
  1. Lauren S. Jammallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia L. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marybeth Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nora K. Horick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melissa N. Skolny
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michelle C. Specht
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean O’Toole
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alphonse G. Taghian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alphonse G. Taghian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jammallo, L.S., Miller, C.L., Singer, M. et al. Impact of body mass index and weight fluctuation on lymphedema risk in patients treated for breast cancer. Breast Cancer Res Treat 142, 59–67 (2013). https://doi.org/10.1007/s10549-013-2715-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-013-2715-7

Keywords

Search

Navigation