title: A contemporary, population-based study of lymphedema risk factors in older women with breast cancer.
abstract: BACKGROUND
  We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.
  
  
  METHODS
  Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries.
  
  
  RESULTS
  Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and in 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were removal of more than five lymph nodes [odds ratio (OR) 4.68-5.61, 95% confidence interval (CI) 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for >15 nodes] and presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24).
  
  
  CONCLUSIONS
  Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors had self-reported lymphedema. In this group of predominantly community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.
authors.affiliation: Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. tyen@mcw.edu
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Fan
authors.forename: Rodney
authors.initials: R
authors.lastname: Sparapani
authors.forename: Purushuttom W
authors.initials: PW
authors.lastname: Laud
authors.forename: Alonzo P
authors.initials: AP
authors.lastname: Walker
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000209:etiology*; D006278:Medicare; D012042:Registries; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D014481:United States