| Risk factors of breast cancer related lymphedema
The lifetime risk of breast cancer is estimated at 1 in 8 for American women. The combination of early detection and improved systemic therapies has resulted in a dramatic decrease in the breast cancer death rate. The American College of Surgeons estimates that there are currently between 1 and 2 million breast cancer survivors in the US. Lymphedema (LE) is a common complication of breast cancer treatment, with a reported incidence between 6 and 30%. There is a possibility that 60,000 and 600,000 women currently are affected by LE in the US and an estimated number of new LE patients in the US ranged from 12,775 to 63,876 in the year 2006. These women face a cosmetic problem, have limited mobility of the affected arm, are at increased risk for infection, miss work more frequently and deal with a problem for which treatment is limited, expensive, time consuming, and impossible to cure. The aim of our study was to determine the risk factors of LE and to investigate if any risk factors are related to the severity of LE. Statistically significant predictors were infection of the arm, BMI and level of hand use. The level of hand use in the control group was categorized low in 54%, medium in 14% and high in 32% patients. The corresponding frequencies were 33%, 14%, and 53% for patients with mild LE and 33%, 11%, and 56% for patients with moderate/severe LE (p < 0.05). Infection of the operated side arm was reported by 2% patients in the control group, 33% patients with mild LE and 56% patients with moderate/severe LE (p < 0.05). The mean BMI was 26.1 kg/m2 (SD 4.9) for the control group, 29.0 (SD 5.9) for the mild LE group and 30.9 (SD 7.5) for patients with moderate/severe LE (p < 0.05). Few trials evaluated coexisting medical disease as a risk factor for BC related LE. HT is reported risk factor for this secondary LE type. In our study 25 % of control patients and 29 % of LE patients were hypertensive (P = 0.589). Other co-existing medical conditions prior surgery such as allergy, hypothyroidism, DM and COPD were not related to the presence of LE as well. Even though it is still difficult to detect all possible risk factors for LE, we conclude that this case-control study identified a high-risk group of patients having LE after breast cancer surgery. Bibliographic
reference:
Professor of Surgery, Director of International Breast Fellowship Program, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
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