Journal of Cancer Survivorship

, Volume 7, Issue 1, pp 115–123 | Cite as

Risk factors associated with breast cancer-related lymphedema in the WHEL Study

  • Sally A. Dominick
  • Lisa Madlensky
  • Loki Natarajan
  • John P. PierceEmail author



Lymphedema is a significant health problem faced by a large percentage of breast cancer survivors. The Women’s Healthy Eating and Living (WHEL) Study has a unique dataset collected after the completion of breast cancer treatment, which allowed a focused analysis of risk factors for breast cancer-related lymphedema.


Participant characteristics, treatment modalities, and health behaviors were examined as potential predictors of lymphedema among breast cancer survivors with univariate analyses and multivariate logistic regression.


Lymphedema status was assessed for 83 % of the study cohort (2,431 of the 2,917 WHEL participants). Among these respondents, 692 (28.5 %) women reported yes to either a physician’s diagnosis of lymphedema or a question on arm/hand swelling. When compared to other participants, women with lymphedema were diagnosed at a younger age, more likely to have a higher body mass index, had a larger tumor size, had more lymph nodes removed, more likely to have a mastectomy with radiation therapy, and more likely to have chemotherapy. In the final multivariate-adjusted model, body mass index greater than 25 kg/m2 (p < 0.01), the removal of 11 or more lymph nodes (p < 0.01), and breast cancer surgery plus radiation therapy (p < 0.01) showed a strong independent association with developing breast cancer-related lymphedema.


The results of this study highlight the importance of educating breast cancer survivors about the modifiable risk factors (e.g., body mass index) associated with the development of lymphedema.

Implications for Cancer Survivors

Breast cancer survivors at risk for lymphedema may benefit from interventions aimed at achieving or maintaining a healthy body weight.


Breast cancer survivors Lymphedema Risk factors Body mass index Lymph node removal Breast cancer treatment 



The WHEL Study was initiated with the support of the Walton Family Foundation and continued with funding from National Cancer Institute grant CA 69375. Some of the data were collected from General Clinical Research Centers, National Institutes of Health grants M01-RR00070, M01-RR00079, and M01-RR00827. Research related to the development of this paper was supported by Award Number T32GM084896 from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences or the National Institutes of Health. Additionally, study investigators would like to thank all WHEL Study participants who contributed time and effort to this research.

Conflict of interest

All authors declare no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Sally A. Dominick
    • 1
  • Lisa Madlensky
    • 1
  • Loki Natarajan
    • 1
  • John P. Pierce
    • 1
    • 2
    Email author
  1. 1.Moores Cancer CenterUniversity of California, San DiegoLa JollaUSA
  2. 2.Cancer Prevention and Control Program, Moores UCSD Cancer CenterUniversity of California, San DiegoLa JollaUSA

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