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Lymphedema After Breast Cancer: Incidence, Risk Factors, and Effect on Upper Body Function

Sandra C. Hayes, Monika Janda, Bruce Cornish, Diana Battistutta, Beth Newman

From the Institute of Health and Biomedical Innovation, School of Public Health; and School of Physical and Chemical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia

Corresponding author: Sandra Hayes, MD, Institute of Health and Biomedical Innovation, School of Public Health, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; e-mail: sc.hayes{at}qut.edu.au

Purpose Secondary lymphedema is associated with adverse physical and psychosocial consequences among women with breast cancer (BC). This article describes the prevalence and incidence of lymphedema between 6 and 18 months after BC treatment; personal, treatment, and behavioral correlates of lymphedema status; and the presence of other upper-body symptoms (UBS) and function (UBF).

Patients and Methods A population-based sample of Australian women (n = 287) with recently diagnosed, invasive BC were evaluated on five occasions using bioimpedance spectroscopy. Lymphedema was diagnosed when the ratio of impedance values, comparing treated and untreated sides, was three standard deviations more than normative data. UBF was assessed using the validated Disability of the Arm, Shoulder, and Hand questionnaire.

Results From 6 to 18 months after surgery, 33% (n = 62) of the sample were classified as having lymphedema; of these, 40% had long-term lymphedema. Although older age, more extensive surgery or axillary node dissection, and experiencing one or more treatment-related complication(s) or symptom(s) at baseline were associated with increased odds, lower socioeconomic status, having a partner, greater child care responsibilities, being treated on the dominant side, participation in regular activity, and having good UBF were associated with decreased odds of lymphedema. Not surprisingly, lymphedema leads to reduced UBF; however, BC survivors report high prevalences of other UBS (34% to 62%), irrespective of their lymphedema status.

Conclusion Lymphedema is a public health issue deserving greater attention. More systematic surveillance for earlier detection and the potential benefits of physical activity to prevent lymphedema and mitigate symptoms warrant further clinical integration and research.

Supported by the National Breast Cancer Foundation (NBCF; funding for the Pulling Through Study) and Johnson and Johnson (contributions to NBCF to fund the fellowship of S.C.H.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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