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Treatments other than surgery may influence risk for breast cancer–related lymphedema
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Rates of lymphedema in patients with breast cancer were higher among those who received chemotherapy, radiation and axillary dissection, according to study data presented at the American Society of Breast Surgeons Annual Meeting.
Thus, the risk for lymphedema appears multifactorial and not impacted by the use of axillary surgery alone, according to the researchers.
“Patients who undergo management of breast cancer tend to be at risk for upper extremity lymphedema,” Judy C. Boughey, MD, FACS, professor of surgery and vice chair of research at Mayo Clinic in Rochester, Minnesota, said during a press conference. “When you look across the literature, the risk for breast cancer–related lymphedema can vary as widely from a 3% incidence to 65% incidence, and this varies based on the treatment, the mode of diagnosis of lymphedema and the time of follow-up.”
Boughey and colleagues evaluated data of 1,794 patients with stage I to stage III breast cancer from the Olmsted County Rochester Epidemiology Project Breast Cohort — a population-based sample of all breast cancer cases of residents in Olmsted County, Minnesota, from 1990 to 2010 — to assess incidence of breast cancer–related lymphedema and risk factors over long-term follow-up.
Among the cohort, 17% had stage 0 cancer, 48% had stage I, 29% had stage II and 6% had stage III. The median age at diagnosis was 60 years, and 44% were overweight or obese.
Over a median follow-up of 10 years, 58.5% of patients underwent lumpectomy, 28% underwent unilateral mastectomy and 13% underwent bilateral mastectomy.
Forty-four percent of patients who underwent axillary dissection, 40% of patients underwent sentinel lymph node biopsy and 16% did not undergo any axillary surgery. In addition, 57% of patients received radiation and 29% received chemotherapy.
The cumulative incidence of breast cancer–related lymphedema within 5 years was 9.1% (95% CI, 7.8-10.5).
Patients who underwent sentinel lymph node biopsy had fewer lymph nodes removed (median, 3 vs. 16; P < .001) and lower 5-year incidence of breast cancer–related lymphedema (5.3% vs. 15.9%; P < .001) than patients who underwent axillary dissection.
All patients with breast cancer–related lymphedema within 5 years had received axillary surgery.
Among patients who underwent sentinel lymph node biopsy, those who also received adjuvant radiotherapy did not have significantly greater rates of breast cancer–related lymphedema than those who did not receive radiation (6.3% vs. 3.6%).
However, patients who underwent axillary dissection and received radiotherapy had higher rates of breast cancer–related lymphedema than patients who did not receive radiation (22.2% vs. 7.8%; P < .001).
Among patients who did not receive any radiotherapy or chemotherapy, the breast cancer–related lymphedema rates were not different between patients who underwent axillary dissection or sentinel lymph node biopsy. Mastectomy vs. lumpectomy also was not associated with an increased risk for breast cancer–related lymphedema.
Multivariate analysis showed axillary dissection (adjusted HR = 2.7; 95% CI, 1.9-3.9) and adjuvant radiotherapy (adjusted HR = 2; 95% CI, 1.3-3.1) increased risk for breast cancer–related lymphedema compared with sentinel lymph node biopsy.
Chemotherapy (HR = 1.8; 95% CI, 1.2-2.8) and stage III disease (HR = 2.2; 95% CI, 1.2-3.7) also increased risk for breast cancer–related lymphedema.
In addition, patients with a BMI of 35 or greater (HR = 1.9; 95% CI, 1-3.3) or of 25 to 34.99 (HR = 1.5; 95% CI, 1.1-2) had a higher risk for breast cancer–related lymphedema than patients with a BMI below 25 (P < .01).
“Breast cancer–related lymphedema risk is a consequence of multimodal treatment of patients undergoing therapy,” Boughey said. “...This study can help identify patients who are at a higher risk for breast cancer–related lymphedema, and we can potentially individualize the surveillance of these patients to allow them to have earlier identification and earlier treatment.” – by Melinda Stevens and Kristie L. Kahl
Reference:
Boughey JC, et al. Breast cancer–related lymphedema risk is related to multidisciplinary treatment and not surgery alone — results from a large cohort study. Presented at: The American Society of Breast Surgeons Annual Meeting; April 26-30, 2017; Las Vegas.
Disclosures: HemOnc Today was unable to confirm Boughey’s relevant financial disclosures at the time of reporting.