Age as a risk factor for breast cancer-related lymphedema: a systematic review



Breast cancer-related lymphedema (BCRL) has been widely reported in the medical literature. Various patient characteristics, including age, have been investigated as possible risk factors for this disease entity, but the existence and direction of the cause-and-effect relationship are still unclear. In this review, we aimed to evaluate the effect of age on development of BRCL.


PubMed, Scopus, and Ovid MEDLINE were searched for relevant articles, which were found to be published between 1974 and 2020.


Twenty-six studies involving 19,396 patients were selected. The average age of patients was 54.9. 26 studies were included in the final analysis, and 13 articles reported no association between age and BCRL development.


Though studies presented different findings, the majority did not identify age as a risk factor for development of lymphedema. However, the level of evidence of individual studies was low. In this article, we call attention to the need for uniform design of lymphedema studies and diagnosis.

Implications for Cancer Survivors

All patients should be informed and screened regularly for lymphedema during and after the treatment independent of their age.

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Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.


  1. 1.

    American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer society, Inc. 2019.

  2. 2.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;0:1–28. doi:, 69.

  3. 3.

    Warren LE, Miller CL, Horick N, et al. The impact of radiation therapy on the risk of LE after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys. 2014;88(3):565–71.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Gillespie TC, Sayegh HE, Brunelle CL, Daniell KM, Taghian AG. Breast cancer-related LE: risk factors, precautionary measures, and treatments. Gland Surg. 2018;7(4):379–403. doi:

  5. 5.

    Lazareth I. Classification des lymphœdèmes. La Revue de Médecine Interne, 23, 375s–378s. 2002.

  6. 6.

    Dominick SA, Natarajan L, Pierce JP, Madanat H, Madlensky L. The psychosocial impact of LE-related distress among breast cancer survivors in the WHEL study. Psychooncology. 2014;23(9):1049–56.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Pereira ES, Moraes ET, Siqueira DM, Santos MA. Stewart Treves syndrome. An Bras Dermatol. 2015;90(3 Suppl 1):229–31.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Mesli SN, Ghouali AK, Benamara F, Taleb FA, Tahraoui H, Abi-Ayad C. Stewart-Treves syndrome involving chronic LE after mastectomy of breast Cancer. Case Rep Surg. 2017;2017:4056459–4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Morrell RM, Halyard MY, Schild SE, Ali MS, Gunderson LL, Pockaj BA. Breast cancer-related LE. Mayo Clin Proc 2005; 80:1480–1484. (PMID: 16295027).

  10. 10.

    Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13. Published 2005 Apr 20. doi:

  11. 11.

    Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, et al. Risk factors for arm LE following breast cancer diagnosis in black women and white women. Breast Cancer Res Treat. 2008;113(2):383–91.

  12. 12.

    Kwan ML, Yao S, Lee VS, Roh JM, Zhu Q, Ergas IJ, et al. Race/ethnicity, genetic ancestry, and breast cancer-related LE in the pathways study. Breast Cancer Res Treat. 2016;159(1):119–29.

  13. 13.

    Geller BM, Vacek PM, O'Brien P, Secker-Walker RH. Factors associated with arm swelling after breast cancer surgery. J Women's Health (Larchmt). 2003;12(9):921–30.

    CAS  Article  Google Scholar 

  14. 14.

    Togawa K, Ma H, Sullivan-Halley J, Neuhouser ML, Imayama I, Baumgartner KB, et al. Risk factors for self-reported arm LE among female breast cancer survivors: a prospective cohort study. Breast Cancer Res. 2014;16:414.

  15. 15.

    Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. LE after breast Cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42.

    Article  PubMed  Google Scholar 

  16. 16.

    Basta MN, Wu LC, Kanchwala SK, Serletti JM, Tchou JC, Kovach SJ, et al. Reliable prediction of postmastectomy LE: the risk assessment tool evaluating LE. The American journal of surgery, 213(6), 1125–1133.e1. 2017.

  17. 17.

    Miller CL, Specht MC, Skolny MN, Horick N, Jammallo LS, O’Toole J, et al. Risk of LE after mastectomy: potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients. Breast Cancer Res Treat. 2014;144(1):71–7.

  18. 18.

    Mak SS, Yeo W, Lee YM, Tse SM, Ho FP, Zee B, et al. Risk factors for the initiation and aggravation of lymphoedema after axillary lymph node dissection for breast cancer. Hong Kong Med J. 2009;15(3 Suppl 4):8–12.

  19. 19.

    Kim M, Park IH, Lee KS, Ro J, Jung SY, Lee S, et al. Breast Cancer-related LE after Neoadjuvant chemotherapy. Cancer Res Treat. 2015;47(3):416–23.

  20. 20.

    Huang H-P, Zeng Q, Zhou J-R. Risk factors associated with lymphoedema among Chinese women after breast cancer surgery. Contemp Nurse. 2013;44(1):5–10.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Graham PH. Compression prophylaxis may increase the potential for flight-associated lymphoedema after breast cancer treatment. Breast. 2002;11(1):66–71.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13(4):491–500.

    Article  PubMed  Google Scholar 

  23. 23.

    Can AG, Ekşioğlu E, Bahtiyarca ZT, Çakcı FA. Assessment of Risk Factors in Patients who presented to the Outpatient Clinic for Breast Cancer-Related LE. J Breast Health. 2016;12(1):31–36. Published 2016 Jan 1. doi:

  24. 24.

    Soyder A, Taştaban E, Özbaş S, Boylu Ş, Özgün H. Frequency of Early-Stage LE and Risk Factors in Postoperative Patients with Breast Cancer. J Breast Health. 2014;10(2):92–97. Published 2014 Apr 1. doi:

  25. 25.

    Dominick SA, Madlensky L, Natarajan L, Pierce JP. Risk factors associated with breast cancer-related LE in the WHEL study. J Cancer Surviv. 2013;7(1):115–23.

    Article  PubMed  Google Scholar 

  26. 26.

    Rupp J, Hadamitzky C, Henkenberens C, Christiansen H, Steinmann D, Bruns F. Frequency and risk factors for arm LE after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation. Radiat Oncol. 2019;14(1):39. Published 2019 Mar 7. doi:

  27. 27.

    Ozcinar B, Guler SA, Kocaman N, Ozkan M, Gulluoglu BM, Ozmen V. Breast cancer related LE in patients with different loco-regional treatments. Breast. 2012;21(3):361–5.

    Article  PubMed  Google Scholar 

  28. 28.

    Kissin MW. Querci della Rovere G, Easton D, Westbury G. risk of lymphoedema following the treatment of breast cancer. Br J Surg. 1986;73(7):580–4.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Segerström K, Bjerle P, Graffman S, Nyström Å. Factors that influence the incidence of brachial Oedema after treatment of breast Cancer. Scand J Plast Reconstr Surg Hand Surg. 1992;26(2):223–7.

    Article  PubMed  Google Scholar 

  30. 30.

    Edwards TL. Prevalence and aetiology of lymphoedema after breast cancer treatment in southern Tasmania. Aust N Z J Surg. 2000;70(6):412–8.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Kwan ML. Risk factors for LE in a prospective breast Cancer survivorship study. Arch Surg. 2010;145(11):1055.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Ozaslan C, Kuru B. LE after treatment of breast cancer. Am J Surg. 2004;187(1):69–72.

    Article  PubMed  Google Scholar 

  33. 33.

    Aoishi Y, Oura S, Nishiguchi H, et al. Risk factors for breast cancer-related LE: correlation with docetaxel administration [published online ahead of print, 2020 Apr 8]. Breast Cancer. 2020; doi:

  34. 34.

    Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl KA, et al. LE secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11(6):573–80.

  35. 35.

    Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM. 2005;98(5):343–8.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Ribeiro Pereira ACP, Koifman RJ, Bergmann A. Incidence and risk factors of LE after breast cancer treatment: 10 years of follow-up. Breast. 2017;36:67–73.

    Article  PubMed  Google Scholar 

  37. 37.

    Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global Cancer in women: burden and trends. Cancer Epidemiol Biomark Prev. 2017;26(4):444–57.

    Article  Google Scholar 

  38. 38.

    Fu MR. Breast cancer-related LE: symptoms, diagnosis, risk reduction, and management. World J Clin Oncol. 2014;5(3):241–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Armer JM, Ballman KV, McCall L, Armer NC, Sun Y, Udmuangpia T, et al. LE symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons oncology group (ACOSOG) Z1071 (Alliance) substudy. Support Care Cancer. 2019;27(2):495–503.

  40. 40.

    Visser J, van Geel M, Cornelissen AJM, van der Hulst RRWJ, Qiu SS. Breast Cancer-related LE and Genetic predisposition: a systematic review of the literature. Lymphat Res Biol. 2019;17(3):288–93.

    Article  PubMed  Google Scholar 

  41. 41.

    Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GKD, Scott-Conner C. LE following breast cancer: The importance of surgical methods and obesity. Front Womens Health. 2018;3(2): doi:

  42. 42.

    Shang T, Liang J, Kapron CM, Liu J. Pathophysiology of aged lymphatic vessels. Aging (Albany NY). 2019;11(16):6602–6613. doi:

  43. 43.

    Adriaenssens N, Verbelen H, Lievens P, Lamote J. LE of the operated and irradiated breast in breast cancer patients following breast conserving surgery and radiotherapy. Lymphology. 2012;45(4):154–64.

    CAS  PubMed  Google Scholar 

  44. 44.

    Ridner SH, Dietrich MS. Self-reported comorbid conditions and medication usage in breast Cancer survivors with and without LE. Oncol Nurs Forum. 2008;35(1):57–63.

    Article  PubMed  Google Scholar 

  45. 45.

    Pezner RD, Patterson MP, Hill LR, Lipsett JA, Desai KR, Vora N, et al. Arm LE in patients treated conservatively for breast cancer: relationship to patient age and axillary node dissection technique. International Journal of Radiation Oncology*Biology*Physics. 1986;12(12):2079–83.

  46. 46.

    Kilbreath SL, Lee MJ, Refshauge KM, Beith JM, Ward LC, Simpson JM, et al. Transient swelling versus lymphoedema in the first year following surgery for breast cancer. Support Care Cancer. 2013;21(8):2207–15.

  47. 47.

    Hahamoff M, Gupta N, Munoz D, Lee BT, Clevenger P, Shaw C, et al. A LE surveillance program for breast Cancer patients reveals the promise of surgical prevention. J Surg Res. 2019;244:604–11.

  48. 48.

    Armer J, Fu MR. Age differences in post-breast cancer LE signs and symptoms. Cancer Nurs. 2005;28:200–7.

  49. 49.

    Blaney JM, McCollum G, Lorimer J, Bradley J, Kennedy R, Rankin JP. Prospective surveillance of breast cancer-related lymphoedema in the first-year post-surgery: feasibility and comparison of screening measures. Support Care Cancer. 2015;23(6):1549–59.

    CAS  Article  PubMed  Google Scholar 

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This study was supported in part by the Mayo Clinic Center for Individualized Medicine, the Mayo Clinic Center for Regenerative Medicine and the Plastic Surgery Foundation.

Author information




All authors contributed to the study conception and design. The idea belonged to Antonio Forte. Literature search, data collection and analysis were performed by Gunel Guliyeva, Maria T. Huayllani, and Daniel Boczar. The first draft of the manuscript was written by Gunel Guliyeva and all authors commented on previous versions of the manuscript. Xiaona Lu and Antonio J. Forte commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Antonio Jorge Forte.

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Conflict of interest

The first author: Gunel Guliyeva declares that there is no conflict of interest regarding the publication of this article.

The second author: Maria T. Huayllani declares that there is no conflict of interest regarding the publication of this article.

The third author: Daniel Boczar declares that there is no conflict of interest regarding the publication of this article.

The fourth author: Francisco R. Avila declares that there is no conflict of interest regarding the publication of this article.

The fifth author: Xiaona Lu declares that there is no conflict of interest regarding the publication of this article.

The corresponding author: Antonio J. Forte declares that there is no conflict of interest regarding the publication of this article.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Guliyeva, G., Huayllani, M.T., Boczar, D. et al. Age as a risk factor for breast cancer-related lymphedema: a systematic review. J Cancer Surviv (2021).

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  • Risk factors
  • Breast Cancer
  • Lymphedema
  • Upper limb lymphedema
  • Age
  • Iatrogenic lymphedema