Several factors associated with development of breast cancer-related lymphedema (BCRL) in patients who have undergone axillary lymph node dissection (ALND) were revealed in a recent study. The study findings were reported in JAMA Oncology.
The study was a prospective analysis of a cohort that included adult female patients seen at a tertiary cancer center. Patients had undergone breast surgery with unilateral ALND. The study investigators evaluated the risk of BCRL in patients in the first 2 years following ALND and radiation therapy, and they also identified risk factors for BCRL. Lymphedema was assessed through measurements of arm volume using a perometer. BCRL was characterized by a relative volume change of 10% or greater compared with baseline.
The study included 304 patients, 276 of whom had any longitudinal measurements available for analysis. The median patient age was 48 years, and the median body mass index was 26.4 kg/m2. Based on self-identification, the majority of patients were White (60%); 20% were Black, 11% were Asian, 6% were Hispanic, and 3% had an unknown race/ethnicity. Most patients (93%) had undergone nodal irradiation, and 70% had been given neoadjuvant chemotherapy. Median follow-up time was 22.6 months.
The 24-month rate of BCRL in this population was 23.8% (95% CI, 17.9%-29.8%). Significant differences in 24-month BCRL rates were apparent based on race/ethnicity (P =.004). Black patients showed the highest 24-month rate (37.2%), whereas the rate was lowest among White patients (19.8%). BCRL rates were 27.7% for Hispanic patients and 22.5% for Asian patients.
Treatment with neoadjuvant chemotherapy was associated with a 29.3% rate of BCRL at 24 months. This was significantly higher than the rate of 11.1% for patients who had upfront surgery (P =.01).
Multivariable analysis indicated several independent factors were associated with a greater odds of having developed BCRL at 24 months. Compared with White race, Black race showed a greater association with BCRL (odds ratio [OR], 3.88; 95% CI, 2.14-7.08), as did Hispanic ethnicity (OR, 3.01; 95% CI, 1.10-7.62).
Use of neoadjuvant chemotherapy was associated with a greater risk of BCRL than upfront surgery (OR, 2.10; 95% CI, 1.16-3.95). Every 1-year increase in age was associated with a greater likelihood of BCRL (OR, 1.04; 95% CI, 1.02-1.07). Every 6-month increase in the time between follow-up visits also was linked to a greater risk of BCRL (OR, 1.57; 95% CI, 1.30-1.90).
One factor that was associated with a lower risk of BCRL was ERBB2-positive cancer subtype, compared with hormone receptor-positive/ERBB2-negative subtype (OR, 0.50; 95% CI, 0.23-0.99).
The study investigators concluded multiple factors were independently associated with BCRL risk. Further research should be conducted to identify biologic mechanisms related to the risk factors for BCRL identified in this study.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Montagna G, Zhang J, Sevilimedu V, et al. Risk factors and racial and ethnic disparities in patients with breast cancer-related lymphedema. JAMA Oncol. Published online June 9, 2022. doi:10.1001/jamaoncol.2022.1628