Debunking the myth of lymphoedema risk
The risk of developing breast cancer-related lymphoedema is associated with a range of factors, not just axillary (armpit) node surgery as is widely believed, a new study reveals.
Lymphoedema is a well-known side effect in women who’ve received treatment for breast cancer. It results in a swelling of the arm and chest area and is often associated with surgery to remove lymph nodes from under the arm.
This new study, presented at the Annual Meeting of the American Society of Breast Surgeons, found that patients who had surgery to their lymph nodes were more likely to contract lymphoedema if they also had:
- more advanced disease
- greater than normal body weight
- radiation therapy.
Study co-author Dr Judy Boughey says it’s important to take into account the wider variety of factors that can impact on lymphoedema.
“The lymphoedema rate was significantly lower among patients undergoing axillary surgery without these additional risk factors,” she says.
“We must recognise that today, breast cancer is no longer a disease treated primarily through surgery, and many therapies impact the risk of this chronic condition. Risk factors appeared to be cumulative, affecting women in a step-like fashion,” Dr Boughey notes.
The research examined nearly 1,800 women with stage 0 to 3 breast cancer between 1990 and 2010 drawn from a large regional database. Of these patients, 59 per cent underwent breast-conserving lumpectomy, 28 per cent unilateral mastectomy and 13 per cent bilateral mastectomy.
The study found no difference in the rate of lymphoedema among patients who underwent mastectomy compared with breast conserving surgery.
The study then looked at the difference between sentinel lymph node biopsy (SLNB), which involves the removal of an average of two or three lymph nodes, and axillary lymph node dissection (ALND), usually involving removal of between 10 and 30 nodes.
They found ALND was not associated with a higher lymphedema rate than SLNB unless chemotherapy or radiation therapy was involved.
In patients who only had surgery as treatment, the risk for SLNB was 4.1 per cent compared to 3.5 per cent for those who had ALND.
The risk increased for those who had ALND plus chemotherapy or radiation therapy to 15.9 per cent versus 5.3 per cent for those receiving SLNB.
In conclusion, the researchers state that lymphoedema was associated with stage II or III disease because patients typically were treated with radiation and/or chemotherapy. Lymphoedema risk was also increased with higher body mass index.
“Clearly, for a realistic perspective on lymphoedema risk, women should talk not only to their surgeons but also to their oncologists and radiation oncologists and take into account the full multidisciplinary treatment that they are undertaking,” Dr. Boughey says.
She also notes that treatment options for lymphoedema have improved during the past decade.
“Patients with a high lymphoedema risk profile should be carefully followed so that any necessary interventions can begin early,” she advises.
Dr. Boughey said that most breast cancer patients are extremely concerned about developing lymphoedema, and this study provides important new information furthering an understanding of the condition.