title: Breast cancer treatment, BMI, post-op swelling/lymphoedema.
abstract: BACKGROUND: Diagnosis of post-breast cancer lymphoedema is difficult because of inconsistent measurement approaches, measurement reliability and validity, and lymphoedema definition and criterion.  AIMS: To examine lymphoedema occurrence using a body mass index (BMI)-adjusted limb volume change (LVC) as a potentially sensitive alternative criterion for assessment and diagnosis of lymphoedema. Secondary aims were to examine the risk of lymphoedema occurrence in relation to post-operative swelling and limb dominance and the cancer-affected side.  METHODS: The volume calculated from circumferences of 193 breast cancer survivors was used to analyse lymphoedema assessment. A change ≥5% in affected-arm volume over percent change in BMI in comparison to pre-operative baseline was considered indicative of lymphoedema.  RESULTS: For all participants, 63% met the 5% BMI-adjusted LVC criterion. Dominant limb and cancer-affected side were significantly related to lymphoedema occurrence only in those whose BMI ≥30 (p=0.02), while post-operative swelling significantly increased the lymphoedema risk irrespective of BMI (p=0.01).  CONCLUSIONS: The proposed 5% BMI-adjusted LVC criterion provides a more sensitive estimation of post-breast cancer lymphoedema occurrence.
authors.affiliation: Wannapa Kay Mahamaneerat is Research Specialist, Sinclair School of Nursing and Ellis Fischel Cancer Center, University of Missouri, and Lecturer of School of Applied Statistics, National Institute of Development Administration, Thailand; Chi-Ren Shyu is Director, Informatics Institute, University of Missouri; Bob R Stewart is Adjunct Clinical Faculty, Sinclair School of Nursing and Professor Emeritus, Agricultural Education, University of Missouri; Jane M Armer is Professor, Sinclair School of Nursing and Ellis Fischel Cancer Center, University of Missouri.
authors.forename: Wannapa Kay
authors.initials: WK
authors.lastname: Mahamaneerat
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Shyu
authors.forename: Bob R
authors.initials: BR
authors.lastname: Stewart
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer