title: Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function.
abstract: OBJECTIVE
  Secondary lymphedema is associated with adverse physical and psychosocial consequences among women with breast cancer (BC). This article describes the prevalence and incidence of lymphedema between 6 and 18 months after BC treatment; personal, treatment, and behavioral correlates of lymphedema status; and the presence of other upper-body symptoms (UBS) and function (UBF).
  
  
  METHODS
  A population-based sample of Australian women (n = 287) with recently diagnosed, invasive BC were evaluated on five occasions using bioimpedance spectroscopy. Lymphedema was diagnosed when the ratio of impedance values, comparing treated and untreated sides, was three standard deviations more than normative data. UBF was assessed using the validated Disability of the Arm, Shoulder, and Hand questionnaire.
  
  
  RESULTS
  From 6 to 18 months after surgery, 33% (n = 62) of the sample were classified as having lymphedema; of these, 40% had long-term lymphedema. Although older age, more extensive surgery or axillary node dissection, and experiencing one or more treatment-related complication(s) or symptom(s) at baseline were associated with increased odds, lower socioeconomic status, having a partner, greater child care responsibilities, being treated on the dominant side, participation in regular activity, and having good UBF were associated with decreased odds of lymphedema. Not surprisingly, lymphedema leads to reduced UBF; however, BC survivors report high prevalences of other UBS (34% to 62%), irrespective of their lymphedema status.
  
  
  CONCLUSIONS
  Lymphedema is a public health issue deserving greater attention. More systematic surveillance for earlier detection and the potential benefits of physical activity to prevent lymphedema and mitigate symptoms warrant further clinical integration and research.
authors.affiliation: Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia. sc.hayes@qut.edu.au
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Hayes
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Bruce
authors.initials: B
authors.lastname: Cornish
authors.forename: Diana
authors.initials: D
authors.lastname: Battistutta
authors.forename: Beth
authors.initials: B
authors.lastname: Newman
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D008875:Middle Aged; D018908:Muscle Weakness / Q000453:epidemiology / Q000209:etiology; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011788:Quality of Life; D016059:Range of Motion, Articular; D012307:Risk Factors; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000503:physiopathology*