Development of breast cancer-related lymphedema: is it dependent on the patient, the tumor or the treating physicians?

INTRODUCTION

Breast cancer-related lymphedema (LE) is relatively common. The aim of this study was to identify the risk factors involved in the development of this complication.

METHODOLOGY

This was a cross-sectional study of breast cancer patients treated at our Center between 2004 and 2009. A total of 515 patients were included. Lymphedema was defined as a mid-arm or forearm circumference difference between both limbs of 2 cm or more.

RESULTS

The incidence of LE in this population was 21.4 %. Patients with a BMI of 25 or higher had a significantly higher risk of LE (p = 0.002). The presence of lymphovascular invasion (LVI) (p = 0.05) and the number of positive lymph nodes (LN) (p = 0.001) were both associated with LE. Patients who underwent axillary dissection (AD) had a significantly higher incidence of LE than patients who had a sentinel LN biopsy (25 vs. 4.5 %). Adjuvant radiotherapy was also a significant risk factor in patients who had a mastectomy (p = 0.003).

CONCLUSION

There are multiple risk factors for LE. Most of those factors can be influenced by early tumor detection. Early tumors are smaller with no LVI or axillary LN metastasis. They do not usually require AD or axillary radiotherapy, which are the strongest factors associated with the development of LE.