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Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis
Author(s) -
Petrek Jeanne A.,
Senie Ruby T.,
Peters Margaret,
Rosen Paul Peter
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010915)92:6<1368::aid-cncr1459>3.0.co;2-9
Subject(s) - medicine , lymphedema , cohort , mastectomy , breast cancer , multivariate analysis , univariate analysis , population , cohort study , surgery , breast carcinoma , cancer , physical therapy , environmental health
BACKGROUND To the authors' knowledge, there are no long‐term cohort studies of lymphedema, despite the substantial morbidity of arm swelling. The goal of this study was to identify prevalence of breast carcinoma–related lymphedema, time of onset, and associated predictive factors. METHODS A cohort of 923 women consecutively treated with mastectomy and complete axillary dissection at our center between 1976 and 1978 was observed intensively for 20 years. Two hundred sixty‐three study subjects (28.5%) who were alive and recurrence free constituted the cohort for the current study. A subset of 52 women (20% of study population) with contralateral mastectomy was analyzed separately. Subjects reported circumferential arm measurements taken using a validated instrument. In addition to providing analysis of clinical and treatment variables, this study is the first to the authors' knowledge to analyze possible etiologic factors in the posttreatment years, such as occupation, general physical activity, and sports/leisure activities. Univariate and multivariate analytic methods were used. RESULTS At 20 years after treatment, 49% (128 of 263) reported the sensation of lymphedema. Arm swelling measurements were severe (≥ 2.0 in [5.08 cm]; patients reported measurement in inches) for 13% (33 of 263 women). Seventy‐seven percent (98 of 128) noted onset within 3 years after the operation; the remaining percentage developed arm swelling at a rate of almost 1% per year. Of the 15 potential predictive factors analyzed, only 2 were statistically significantly associated with lymphedema: arm infection/injury and weight gain since operation ( P < 0.001 and P = 0.02, respectively). CONCLUSIONS This defined cohort, treated by axillary dissection 20 years ago, documents the high prevalence of lymphedema and its time course. Two significantly associated factors, both potentially controllable, are identified. The current study provides further support for treatments that limit lymph node dissection. The authors are prospectively evaluating patients undergoing sentinel lymph node biopsy. Cancer 2001;92:1368–77. © 2001 American Cancer Society.