Lymphedema Prominent in Early Breast Cancer Survivors

Lymphedema Prominent in Early Breast Cancer Survivors
Risks appear higher in African-American women, those with higher education levels

New Study Published at http://archsurg.ama-assn.org/cgi/content/abstract/145/11/1055

Risk Factors for Lymphedema in a Prospective Breast Cancer Survivorship Study

The Pathways Study

Marilyn L. Kwan, PhD; Jeanne Darbinian, MS, RD; Kathryn H. Schmitz, PhD; Rebecca Citron; Paula Partee, MPH; Susan E. Kutner, MD; Lawrence H. Kushi, ScD
Arch Surg. 2010;145(11):1055-1063. doi:10.1001/archsurg.2010.231

Objective To determine the incidence of breast cancer–related lymphedema (BCRL) during the early survivorship period as well as demographic, lifestyle, and clinical factors associated with BCRL development.

Design The Pathways Study, a prospective cohort study of breast cancer survivors with a mean follow-up time of 20.9 months.

Setting Kaiser Permanente Northern California medical care program.
Participants We studied 997 women diagnosed from January 9, 2006, through October 15, 2007, with primary invasive breast cancer and who were at least 21 years of age at diagnosis, had no history of any cancer, and spoke English, Spanish, Cantonese, or Mandarin.
Main Outcome Measure Clinical indication for BCRL as determined from outpatient or hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders.

Results A clinical indication for BCRL was found in 133 women (13.3%), with a mean time to diagnosis of 8.3 months (range, 0.7-27.3 months). Being African American (hazard ratio, 1.93; 95% confidence interval, 1.00-3.72) or more educated (P for trend = .03) was associated with an increased risk of BCRL. Removal of at least 1 lymph node (hazard ratio, 1.04; 95% confidence interval, 1.02-1.07) was associated with an increased risk, yet no significant association was observed for type of lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (hazard ratio, 1.43; 95% confidence interval, 0.88-2.31).
Conclusions In a large cohort study, BCRL occurs among a substantial proportion of early breast cancer survivors. Our findings agree with those of previous studies on the increased risk of BCRL with removal of lymph nodes and being obese, but they point to a differential risk according to race or ethnicity.

Author Affiliations: Division of Research, Kaiser Permanente Northern California, Oakland (Drs Kwan and Kushi and Mss Darbinian, Citron, and Partee); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (Dr Schmitz); and San Jose Medical Center, Kaiser Permanente Northern California, San Jose (Dr Kutner).