title: Risk factors for lymphoedema in women with breast cancer: A large prospective cohort.
abstract: A prospective study was conducted to identify women at increased risk for lymphoedema (LE) based on axillary surgery. Assessment occurred prior to surgery, within 4 weeks, and at 6, 12 and 18 months following surgery. Following post-surgery assessment, women were asked to complete weekly diaries regarding events that occurred in the previous week. Risk factors were grouped into demographic, lifestyle, breast cancer treatment-related, arm swelling-related, and post-surgical activities. Bioimpedance spectroscopy thresholds were used to determine presence of LE. At 18-months, 241 women with <5 nodes removed and 209 women with ≥5 nodes removed were assessed. For those with <5 nodes removed, LE was present in 3.3% compared with 18.2% for those with ≥5 nodes removed. There were insufficient events to identify risk factors for those with <5 nodes removed; for those with >5 nodes removed, independent risk factors included presence of arm swelling at 12-months (Odds Ratio (OR): 13.5, 95% CI 4.8, 38.1; P < 0.01), at 6-months (5.6 (2.0, 16.9); P < 0.01), and radiotherapy to the axilla (2.6 (0.7, 8.9); P = 0.14). Arm swelling at 6 and 12 months was associated with taxane-based chemotherapy, high body weight at diagnosis and arm swelling within 4 weeks post-surgery. Of the post-surgical events assessed in a sub-group of women with >5 nodes removed and who maintained weekly diaries, only blood drawn from the 'at-risk' arm was identified as a potential risk (OR 2.0; 0.8, 5.2). For women with ≥5 nodes removed, arm swelling in the first year poses a very strong risk for presence of LE at 18-months.
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia. Electronic address: sharon.kilbreath@sydney.edu.au.
authors.forename: S L
authors.initials: SL
authors.lastname: Kilbreath
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: K M
authors.initials: KM
authors.lastname: Refshauge
authors.affiliation: Chris O'Brien Lifehouse, Camperdown, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Beith
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia; School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.
authors.forename: L C
authors.initials: LC
authors.lastname: Ward
authors.affiliation: Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: O A
authors.initials: OA
authors.lastname: Ung
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: E S
authors.initials: ES
authors.lastname: Dylke
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: French
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Yee
authors.affiliation: Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Koelmeyer
authors.affiliation: Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Gaitatzis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001132:Arm; D001365:Axilla; D001835:Body Weight; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D018962:Phlebotomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors
chemical_list: D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane
keywords: Air travel; Arm swelling; Axillary lymph node dissection; Blood pressure; Exercise; Needle punctures