Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors.
OBJECTIVE
Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery.


METHODS
Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements.


RESULTS
Current arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P = .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema.


CONCLUSIONS
Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.
Breast Service, Department of Surgery, Behavioral Science Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Sarah A
SA
McLaughlin
Mary J
MJ
Wright
Katherine T
KT
Morris
Michelle R
MR
Sampson
Julia P
JP
Brockway
Karen E
KE
Hurley
Elyn R
ER
Riedel
Kimberly J
KJ
Van Zee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D010465:Perception; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors