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Breast Cancer Related Lymphedema: An Analysis Of Risk Factors
Charalampos Siotos, MD, Sydney Horen, BS, Anuja Antony, MD, Deana Shenaq, MD, George Kokosis, MD.
Rush University Medical Center, Chicago, IL, USA.

PURPOSE: Breast cancer related lymphedema is a devastating condition that negatively affects quality of life. We aimed to identify risk factors related to lymphedema development and factors that portended early lymphedema development.
METHODS: We identified patients with breast cancer that underwent sentinel lymph node biopsy (SLNBx) or axillary lymph node dissection (ALND) and extracted their sociodemographic and clinical information. Logistic regression identified risk factors related to lymphedema. Time to event analysis and cox-regression analysis identified factors related to earlier development of lymphedema.
RESULTS: We identified 1,100 patients, of which 143(13%) developed upper extremity lymphedema. The average time to lymphedema was 1.9(SD=2.3) years post-operatively. Patients with SLNBx had significantly lower odds for lymphedema (vs. ALND, OR=0.24[0.12-0.47]). African American patients (vs. Caucasian, OR=1.84[1.08-3.14]), patients with stage II, III, and IV disease (vs. stage 0, OR=3.74[1.38-10.12]; OR=5.86[1.89-18.10]; OR=8.20[2.66-25.24]), and patients with Medicaid (vs. private insurance, OR=3.75[1.73-8.13]) had higher rates of lymphedema. No differences were identified based on receipt of radiation, type of mastectomy, or receipt of breast reconstruction. Cox-regression analysis showed that African American (HR=1.63[1.02-2.63]), higher BMI (HR=1.04[1.01-1.06]), higher stage (stageIII, HR=3.55[1.29-9.83]; stageIV, HR=4.02[1.47-10.99]), and Medicaid patients (HR=2.35[1.34-4.11]) had higher hazards for lymphedema. Patients with SLNBx had lower hazards for lymphedema (HR=0.34[0.20-0.57]) (Figure).
CONCLUSION: Lymphedema development has identifiable risk factors. Clinicians should be aware of these factors to better educate their patients and guide management.


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