Skip to main content
Top
Published in: Surgery Today 1/2014

01-01-2014 | Original Article

Development of breast cancer-related lymphedema: is it dependent on the patient, the tumor or the treating physicians?

Authors: Basem Morcos, Firas Al Ahmad, Iyad Anabtawi, Abdel Munem Abu Sba’, Hisham Shabani, Rawya Yaseen

Published in: Surgery Today | Issue 1/2014

Login to get access

Abstract

Introduction

Breast cancer-related lymphedema (LE) is relatively common. The aim of this study was to identify the risk factors involved in the development of this complication.

Methodology

This was a cross-sectional study of breast cancer patients treated at our Center between 2004 and 2009. A total of 515 patients were included. Lymphedema was defined as a mid-arm or forearm circumference difference between both limbs of 2 cm or more.

Results

The incidence of LE in this population was 21.4 %. Patients with a BMI of 25 or higher had a significantly higher risk of LE (p = 0.002). The presence of lymphovascular invasion (LVI) (p = 0.05) and the number of positive lymph nodes (LN) (p = 0.001) were both associated with LE. Patients who underwent axillary dissection (AD) had a significantly higher incidence of LE than patients who had a sentinel LN biopsy (25 vs. 4.5 %). Adjuvant radiotherapy was also a significant risk factor in patients who had a mastectomy (p = 0.003).

Conclusion

There are multiple risk factors for LE. Most of those factors can be influenced by early tumor detection. Early tumors are smaller with no LVI or axillary LN metastasis. They do not usually require AD or axillary radiotherapy, which are the strongest factors associated with the development of LE.
Literature
1.
go back to reference Macdonald I. Resection of the axillary vein in radical mastectomy: its relation to the mechanism of lymphoedema. Cancer. 1948;1:618–24.CrossRef Macdonald I. Resection of the axillary vein in radical mastectomy: its relation to the mechanism of lymphoedema. Cancer. 1948;1:618–24.CrossRef
2.
go back to reference Schünemann H, Willich N. Lymphoedema of the arm after primary treatment of breast cancer. Anticancer Res. 1998;18(3C):2235–6.PubMed Schünemann H, Willich N. Lymphoedema of the arm after primary treatment of breast cancer. Anticancer Res. 1998;18(3C):2235–6.PubMed
3.
go back to reference Mortimer PS BD, Brassington HD, Stanton AWB, Strachan DO, Levic JR. The prevalence of arm oedema following treatment for breast cancer. Q J Med. 1996;89:377–80. Mortimer PS BD, Brassington HD, Stanton AWB, Strachan DO, Levic JR. The prevalence of arm oedema following treatment for breast cancer. Q J Med. 1996;89:377–80.
4.
go back to reference Coen JJ, Taghian AG, Kachnic LA, Assaad SI, Powell SN. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys. 2003;55(5):1209–15.PubMedCrossRef Coen JJ, Taghian AG, Kachnic LA, Assaad SI, Powell SN. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys. 2003;55(5):1209–15.PubMedCrossRef
5.
go back to reference Stanton AW, Svensson WE, Mellor RH, Peter AM, Levick JR, Mortimer PS. Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema. Clin Sci (Lond). 2001;101(2):131–40.CrossRef Stanton AW, Svensson WE, Mellor RH, Peter AM, Levick JR, Mortimer PS. Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema. Clin Sci (Lond). 2001;101(2):131–40.CrossRef
6.
go back to reference Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer 1998;83(12 Suppl American):2776–81. Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema. Cancer 1998;83(12 Suppl American):2776–81.
7.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
8.
go back to reference Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111.PubMedCrossRef Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111.PubMedCrossRef
9.
go back to reference Norman SA, Localio AR, Kallan MJ, Weber AL, Torpey HS, Potashnik SL, et al. Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2734–46.PubMedCentralPubMedCrossRef Norman SA, Localio AR, Kallan MJ, Weber AL, Torpey HS, Potashnik SL, et al. Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2734–46.PubMedCentralPubMedCrossRef
10.
go back to reference Ahmed RL, Schmitz KH, Prizment AE, Folson AR. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res Treat. 2011;130:981–91.PubMedCrossRef Ahmed RL, Schmitz KH, Prizment AE, Folson AR. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res Treat. 2011;130:981–91.PubMedCrossRef
11.
go back to reference Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner S, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg. 2010;145(11):1055–63.PubMedCentralPubMedCrossRef Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner S, et al. Risk factors for lymphedema in a prospective breast cancer survivorship study: the Pathways Study. Arch Surg. 2010;145(11):1055–63.PubMedCentralPubMedCrossRef
12.
go back to reference Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl K, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11(6):573–80.PubMedCrossRef Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl K, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11(6):573–80.PubMedCrossRef
13.
go back to reference Armer J, Fu MR. Age differences in post-breast cancer lymphedema signs and symptoms. Cancer Nurs 2005;28(3):200–7 (quiz 208–9). Armer J, Fu MR. Age differences in post-breast cancer lymphedema signs and symptoms. Cancer Nurs 2005;28(3):200–7 (quiz 208–9).
14.
go back to reference Park JH, Lee WH, Chung HS. Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs. 2008;17(11):1450–9.PubMedCrossRef Park JH, Lee WH, Chung HS. Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs. 2008;17(11):1450–9.PubMedCrossRef
15.
go back to reference Pezner RD, Patterson MP, Hill LR, Lipsett JA, Desai KR, Vora N, et al. Arm lymphedema in patients treated conservatively for breast cancer: relationship to patient age and axillary node dissection technique. Int J Radiat Oncol Biol Phys. 1986;12(12):2079–83.PubMedCrossRef Pezner RD, Patterson MP, Hill LR, Lipsett JA, Desai KR, Vora N, et al. Arm lymphedema in patients treated conservatively for breast cancer: relationship to patient age and axillary node dissection technique. Int J Radiat Oncol Biol Phys. 1986;12(12):2079–83.PubMedCrossRef
16.
go back to reference McLaughlin SA, Wright MJ, Morris KT, Gladys LG, Sampson MR, Brockway JP, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–9.PubMedCrossRef McLaughlin SA, Wright MJ, Morris KT, Gladys LG, Sampson MR, Brockway JP, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213–9.PubMedCrossRef
17.
go back to reference Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010;16(1):48–54.PubMedCrossRef Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010;16(1):48–54.PubMedCrossRef
18.
go back to reference Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007;110(8):1868–74.PubMedCrossRef Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007;110(8):1868–74.PubMedCrossRef
19.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
20.
go back to reference Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42.PubMedCrossRef Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536–42.PubMedCrossRef
21.
go back to reference Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G. Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer. 2001;92(7):1783–7.PubMedCrossRef Herd-Smith A, Russo A, Muraca MG, Del Turco MR, Cardona G. Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer. 2001;92(7):1783–7.PubMedCrossRef
22.
go back to reference Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245(3):452–61.PubMedCrossRef Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245(3):452–61.PubMedCrossRef
23.
go back to reference Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8.PubMedCentralPubMedCrossRef Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8.PubMedCentralPubMedCrossRef
24.
go back to reference Wernicke AG, Goodman RL, Turner BC, Komarnicky LT, Curran WJ, Christos PJ, et al. A 10-year follow-up of treatment outcomes in patients with early stage breast cancer and clinically negative axillary nodes treated with tangential breast irradiation following sentinel lymph node dissection or axillary clearance. Breast Cancer Res Treat. 2011;125(3):893–902.PubMedCentralPubMedCrossRef Wernicke AG, Goodman RL, Turner BC, Komarnicky LT, Curran WJ, Christos PJ, et al. A 10-year follow-up of treatment outcomes in patients with early stage breast cancer and clinically negative axillary nodes treated with tangential breast irradiation following sentinel lymph node dissection or axillary clearance. Breast Cancer Res Treat. 2011;125(3):893–902.PubMedCentralPubMedCrossRef
25.
go back to reference Edwards TL. Prevalence and aetiology of lymphoedema after breast cancer treatment in southern Tasmania. Aust N Z J Surg. 2000;70(6):412–8.PubMedCrossRef Edwards TL. Prevalence and aetiology of lymphoedema after breast cancer treatment in southern Tasmania. Aust N Z J Surg. 2000;70(6):412–8.PubMedCrossRef
26.
go back to reference Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10(5):405–11.PubMedCrossRef Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10(5):405–11.PubMedCrossRef
27.
go back to reference Haid A, Kuehn T, Konstantiniuk P, Koeberle-Wuehrer R, Knauer M, Kreienberg R, et al. Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol. 2002;28(7):705–10.PubMedCrossRef Haid A, Kuehn T, Konstantiniuk P, Koeberle-Wuehrer R, Knauer M, Kreienberg R, et al. Shoulder-arm morbidity following axillary dissection and sentinel node only biopsy for breast cancer. Eur J Surg Oncol. 2002;28(7):705–10.PubMedCrossRef
28.
go back to reference Swenson KK, Nissen MJ, Ceronsky C. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol. 2002;9:745–53.PubMedCrossRef Swenson KK, Nissen MJ, Ceronsky C. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol. 2002;9:745–53.PubMedCrossRef
29.
go back to reference Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000;88(3):608–14.PubMedCrossRef Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000;88(3):608–14.PubMedCrossRef
30.
go back to reference Leidenius M, Leivonen M, Vironen J, von Smitten K. The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J Surg Oncol. 2005;92(1):23–31.PubMedCrossRef Leidenius M, Leivonen M, Vironen J, von Smitten K. The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J Surg Oncol. 2005;92(1):23–31.PubMedCrossRef
31.
go back to reference Yen TW, Fan X, Sparapani R, Laud PW, Walker AP, Nattinger AB. A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol. 2009;16(4):979–88.PubMedCentralPubMedCrossRef Yen TW, Fan X, Sparapani R, Laud PW, Walker AP, Nattinger AB. A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol. 2009;16(4):979–88.PubMedCentralPubMedCrossRef
32.
go back to reference Halsted WS. The swelling of the arm after operations for cancer of the breast—elephantiasis chirurgica: its cause and prevention. Bull John Hopkins Hosp. 1921;32:309–13. Halsted WS. The swelling of the arm after operations for cancer of the breast—elephantiasis chirurgica: its cause and prevention. Bull John Hopkins Hosp. 1921;32:309–13.
33.
go back to reference Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337(14):949–55.PubMedCrossRef Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337(14):949–55.PubMedCrossRef
34.
go back to reference Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–8.PubMedCrossRef Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–8.PubMedCrossRef
Metadata
Title
Development of breast cancer-related lymphedema: is it dependent on the patient, the tumor or the treating physicians?
Authors
Basem Morcos
Firas Al Ahmad
Iyad Anabtawi
Abdel Munem Abu Sba’
Hisham Shabani
Rawya Yaseen
Publication date
01-01-2014
Publisher
Springer Japan
Published in
Surgery Today / Issue 1/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-013-0494-8

Other articles of this Issue 1/2014

Surgery Today 1/2014 Go to the issue