Occurrence of Lymphedema Continues To Increase Twelve to Thirty Months after Breast Cancer Treatment.
Authors: J. Armer, B. Stewart, R. Shook
Journal: Cancer Research (2009)

Abstract Introduction:Breast cancer (BC) survivors are at lifetime risk for developing lymphedema (LE), the accumulation of protein-rich fluid in the interstitial spaces of the affected body part due to a blockage or malfunction in the lymph system. This is different than swelling which may occur immediately after surgery and may be present at the post-op visit, and the physical and psychological aspects of the condition greatly impact the daily lives of LE patients (Geller et al., 2003, Hull, 1998). Of those affected by breast cancer, up to 40% will develop LE, potentially comprising 1 to 5 million survivors. However, all breast cancer survivors are considered at risk for the condition (American Cancer Society, 2007).While numerous studies have reported LE incidence during the first 12 months following breast cancer treatment, little is known regarding long-term LE diagnosis. Very few studies have examined LE incidence past 1 year post-treatment, and many that have are retrospective or cross-sectional, not prospective, in nature. In fact, in one analysis of existing literature the study with the shortest follow-up (12 months) reported the lowest LE incidence (Ball et al., 1992) and the study with the longest follow-up (11 years) reported the highest incidence (Schunemann and Willich, 1997).Methods:Participants were enrolled following diagnosis of BC but before treatment and followed every 3 months for 12 months, then every 6 months until 2.5 years post-surgery. Limb volume changes (LVC) were measured using: (a) circumferences via tape measure at 4 cm intervals, (b) infra-red laser perometry, and (c) symptom experience (SS) via interview. Four diagnostic criteria for LE were used: (i) 2 cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) report of limb heaviness/swelling, 'now' or 'in the past year'. Standard survival analysis methods were applied to identify when the LE criteria were met.Results:At 30 months post-treatment, LE incidence using the four criteria ranged from 41%- 91% and had continued to increase over time, with 2 cm being the highest estimation method and SS the lowest.Conclusions:These preliminary findings provide additional evidence that BC survivors continue to be at risk for developing LE beyond the first year following treatment. LE identification, regardless of the criteria used, continued to increase past the initial 12 months post-treatment. From month 12 to month 30, LE identification increased by an additional 10-27%, depending on the criteria used. While identification of LE via symptom experience in the initial 12 months occurred in 31% of participants, only an additional 10% met the criteria at 30 months, by far the lowest incidence rate among all criteria. Overall, this analysis finds 2 cm criteria as the most liberal definition of LE (91%), while self-report of heaviness and swelling, along with 10% LVC, represent the most conservative definitions (41% and 45%, respectively). Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2070.