title: Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong.
abstract: BACKGROUND
  The incidence rate of breast cancer is rising rapidly in Hong Kong. Lymphedema is a serious long-term complication of breast cancer surgery and radiation therapy.
  
  
  OBJECTIVE
  The objectives of this study were to evaluate risk factors associated with the development of lymphedema for patients with breast cancer who have had an axillary lymph node dissection and to explore potential factors associated with moderate to severe lymphedema.
  
  
  METHODS
  This was a matched case-control study of 202 women undergoing a unilateral axillary dissection for breast cancer, consisting of 101 cases with lymphedema and 101 controls who matched cases in terms of surgery date, axillary radiotherapy, and cancer stage. Arm circumferences were measured to determine presence and severity of lymphedema. Potential risk factors were collected by using clinical data and a questionnaire. A multiple logistic regression was used to obtain the adjusted odds ratios for potential risk factors for developing lymphedema. Exploratory analysis was also performed to identify factors associated with the development of moderate to severe lymphedema.
  
  
  RESULTS
  Adjusted odds ratios for the development of lymphedema were 3.80 (95% confidence interval [CI] = 1.84-7.87) for previous inflammation-infection and 1.06 (95% CI = 1.02-1.10) for an increase of 1 year of age at axillary dissection. On exploratory analysis, adjusted odds ratios for moderate to severe degree of lymphedema were 4.53 (95% CI = 2.16-9.52) for previous inflammation-infection, 2.94 (95% CI = 1.44-6.03) for operation on dominant arm, 1.11 (95% CI = 1.01-1.22) for an increase of 1 kg/m in body mass index (BMI) at recruitment, and 1.05 (95% CI = 1.01-1.10) for an increase of 1 year of age at recruitment time.
  
  
  CONCLUSIONS
  Previous inflammation-infection and advanced age at axillary dissection are risk factors associated with the initiation of lymphedema. Previous inflammation-infection, operation on the side of the dominant hand, obesity, and aging are potential risk factors associated with the aggravation of lymphedema. Greater BMI is still a risk factor for lymphedema progression even in a lower BMI population.
authors.affiliation: Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region, China. s_mak@clo.cuhk.edu.hk
authors.forename: So Shan
authors.initials: SS
authors.lastname: Mak
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.forename: Yik Mun
authors.initials: YM
authors.lastname: Lee
authors.forename: Kwok Fai
authors.initials: KF
authors.lastname: Mo
authors.forename: Ka Yin
authors.initials: KY
authors.lastname: Tse
authors.forename: Sut Mun
authors.initials: SM
authors.lastname: Tse
authors.forename: Fung Ping
authors.initials: FP
authors.lastname: Ho
authors.forename: Wing Hong
authors.initials: WH
authors.lastname: Kwan
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D000886:Anthropometry; D001365:Axilla; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008019:Life Style; D016015:Logistic Models; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009730:Nursing Assessment; D015399:Nursing Research; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires