title: Lymphedema in breast cancer survivors: incidence, degree, time course, treatment, and symptoms.
abstract: OBJECTIVE
  To examine the incidence, degree, time course, treatment, and symptoms of lymphedema in breast cancer survivors.
  
  
  METHODS
  We conducted a 5-year, population-based prospective study of 631 randomly selected Philadelphia and Delaware County, Pennsylvania female residents with incident breast cancer who were diagnosed from 1999 to 2001. Using a questionnaire previously validated against physical therapists' measurement-based clinical criteria, we assigned a score indicating the degree of lymphedema (none, mild, or moderate/severe) to each month of follow-up based on the respondent's perceived differences in hand/arm size. Standard survival analysis methods permitted maximum use of follow-up.
  
  
  RESULTS
  Five-year cumulative incidence of lymphedema was 42 (42%) per 100 women. Among the 238 affected women, lymphedema first occurred within 2 years of diagnosis in 80% and within 3 years in 89%. Among 433 women observed for 3 years, 23% reported no more than mild lymphedema, 12% reported moderate/severe lymphedema, and 2% reported chronically moderate/severe lymphedema. Women with mild lymphedema were more than three times more likely to develop moderate/severe lymphedema than women with no lymphedema. Thirty-seven percent of women with mild lymphedema and 68% with moderate/severe lymphedema received treatment. Increasing proportions of women with increasing degree of lymphedema reported symptoms (eg, jewelry too tight, tired/thick/heavy arm). Symptoms present before the first occurrence of lymphedema were associated with a higher probability of later lymphedema (eg, hazard ratio for jewelry too tight = 7.37; 95% CI, 4.26 to 12.76).
  
  
  CONCLUSIONS
  Lymphedema after breast cancer is common but mostly mild. Subtle differences in self-reported hand/arm size and symptoms can be early signs of progressing lymphedema.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Center for Clinical Epidemiologyand Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. snorman@mail.med.upenn.edu
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Norman
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Potashnik
authors.forename: Heather A
authors.initials: HA
authors.lastname: Simoes Torpey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kallan
authors.forename: Anita L
authors.initials: AL
authors.lastname: Weber
authors.forename: Linda T
authors.initials: LT
authors.lastname: Miller
authors.forename: Angela
authors.initials: A
authors.lastname: Demichele
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Solin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires