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- Title
Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study.
- Authors
Togawa, Kayo; Ma, Huiyan; Sullivan-Halley, Jane; Neuhouser, Marian L.; Imayama, Ikuyo; Baumgartner, Kathy B.; Smith, Ashley Wilder; Alfano, Catherine M.; McTiernan, Anne; Ballard-Barbash, Rachel; Bernstein, Leslie
- Abstract
Introduction Lymphedema is a potentially debilitating condition that occurs among breast cancer survivors. This study examines the incidence of self-reported lymphedema, timing of lymphedema onset, and associations between sociodemographic, clinical and lifestyle factors and lymphedema risk across racial-ethnic groups using data from a multi-center, multi-ethnic prospective cohort study of breast cancer survivors, the Health, Eating, Activity and Lifestyle Study. Methods 666 women diagnosed with breast cancer staged as in situ, localized or regional disease at ages 35 to 64 years were recruited through the Surveillance, Epidemiology, and End Results registries in New Mexico (non-Hispanic white and Hispanic white), Los Angeles County (black), and Western Washington (non-Hispanic white) and followed for a median of 10.2 years. We evaluated sociodemographic factors, breast cancer- and treatment-related factors, comorbidities, body mass index (BMI), hormonal factors, and lifestyle factors in relation to self-reported lymphedema by fitting Cox proportional hazards models, estimating hazard ratios (HR) and 95% confidence intervals (CI).Results Over the follow-up period, 190 women (29%) reported lymphedema. The median time from breast cancer diagnosis to onset of lymphedema was 10.5 months (range: 0.5 to 134.9 months). Factors independently associated with lymphedema were total/modified radical mastectomy (versus partial/less than total mastectomy; HR = 1.37, 95% CI: 1.01 to 1.85), chemotherapy (versus no chemotherapy; HR = 1.48, 95% CI: 1.09 to 2.02), no lymph nodes removed (versus ⩾10 lymph nodes removed; HR = 0.17, 95% CI: 0.08 to 0.33), prediagnostic BMI ⩾30 kg/m2 (versus BMI <25 kg/m2; HR = 1.59, 95% CI: 1.09 to 2.31), and hypertension (versus no hypertension; HR = 1.49, 95% CI: 1.06 to 2.10). After adjusting for demographics and breast cancer- and treatment-related factors, no significant difference in lymphedema risk was observed across racial-ethnic groups. Analyses stratified by race/ethnicity showed that hypertension and chemotherapy were lymphedema risk factors only for black women. Conclusions Breast cancer patients who have undergone extensive surgery or extensive lymph node dissection, or who have a higher BMI should be closely monitored for detection and treatment of lymphedema. Further studies are needed to understand the roles of chemotherapy and hypertension in the development of lymphedema.
- Subjects
LYMPHEDEMA; LYMPHEDEMA treatment; BREAST cancer patients; BREAST cancer treatment; PATIENTS; DISEASE risk factors
- Publication
Breast Cancer Research, 2014, Vol 16, Issue 4, p2
- ISSN
1465-5411
- Publication type
Article
- DOI
10.1186/s13058-014-0414-x