A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol 2009 Apr;16(4):979-88
Date
02/06/2009Pubmed ID
19194754Pubmed Central ID
PMC2729500DOI
10.1245/s10434-009-0347-2Scopus ID
2-s2.0-62149131066 (requires institutional sign-in at Scopus site) 79 CitationsAbstract
BACKGROUND: We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.
METHODS: Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries.
RESULTS: Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and in 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were removal of more than five lymph nodes [odds ratio (OR) 4.68-5.61, 95% confidence interval (CI) 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for >15 nodes] and presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24).
CONCLUSIONS: Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors had self-reported lymphedema. In this group of predominantly community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.
Author List
Yen TW, Fan X, Sparapani R, Laud PW, Walker AP, Nattinger ABAuthors
Purushottam W. Laud PhD Adjunct Professor in the Data Science Institute department at Medical College of WisconsinAnn B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Data Science Institute department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Age FactorsAged
Aged, 80 and over
Breast Neoplasms
Female
Health Surveys
Humans
Lymph Node Excision
Lymphedema
Medicare
Registries
Risk Factors
Sentinel Lymph Node Biopsy
United States
