title: Prevalence and prognostic significance of secondary lymphedema following breast cancer.
abstract: BACKGROUND
  The adverse consequences of lymphedema following breast cancer in relation to physical function and quality of life are clear; however, its potential relationship with survival has not been investigated. Our purpose was to determine the prevalence of lymphedema and associated upper-body symptoms at 6 years following breast cancer and to examine the prognostic significance of lymphedema with respect to overall 6-year survival (OS).
  
  
  RESULTS
  A population-based sample of Australian women (n = 287) diagnosed with invasive, unilateral breast cancer was followed for a median of 6.6 years and prospectively assessed for lymphedema (using bioimpedance spectroscopy [BIS], sum of arm circumferences [SOAC], and self-reported arm swelling), a range of upper-body symptoms, and vital status. OS was measured from date of diagnosis to date of death or last follow-up. Kaplan-Meier methods were used to calculate OS and Cox proportional hazards models quantified the risk associated with lymphedema. Approximately 45% of women had reported at least one moderate to extreme symptom at 6.6 years postdiagnosis, while 34% had shown clinical evidence of lymphedema, and 48% reported arm swelling at least once since baseline assessment. A total of 27 (9.4%) women died during the follow-up period, and lymphedema, diagnosed by BIS or SOAC between 6-18 months postdiagnosis, predicted mortality (BIS: HR = 2.5; 95% CI: 0.9, 6.8, p = 0.08; SOAC: 3.0; 95% CI: 1.1, 8.7, p = 0.04). There was no association (HR = 1.2; 95% CI: 0.5, 2.6, p = 0.68) between self-reported arm swelling and OS.
  
  
  CONCLUSIONS
  These findings suggest that lymphedema may influence survival following breast cancer treatment and warrant further investigation in other cancer cohorts and explication of a potential underlying biology.
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. sc.hayes@qut.edu.au
authors: Sandi
authors: S
authors: Hayes
authors: Tracey
authors: T
authors: Di Sipio
authors: Sheree
authors: S
authors: Rye
authors: J Alejandro
authors: JA
authors: López
authors: Christobel
authors: C
authors: Saunders
authors: Chris
authors: C
authors: Pyke
authors: John
authors: J
authors: Bashford
authors: Diana
authors: D
authors: Battistutta
authors: Beth
authors: B
authors: Newman
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors