Originally published as JCO Early Release 10.1200/JCO.2008.16.3766 on October 6 2008

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Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Patient Perceptions and Precautionary Behaviors

Sarah A. McLaughlin, Mary J. Wright, Katherine T. Morris, Michelle R. Sampson, Julia P. Brockway, Karen E. Hurley, Elyn R. Riedel, Kimberly J. Van Zee

From the Breast Service, Department of Surgery; Behavioral Science Service, Department of Psychiatry and Behavorial Science; and the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Kimberly J. Van Zee, MS, MD, 1275 York Ave, MRI 1026, New York, NY 10065; e-mail: vanzeek{at}mskcc.org

Purpose Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery.

Patients and Methods Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements.

Results Current arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P < .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P < .0001), higher body mass index (P < .0001), infection (P < .0001), and injury (P = .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema.

Conclusion Body weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patient-perceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it.

published online ahead of print at www.jco.org on October 6, 2008.

Supported by National Cancer Institute Grant No. K07 CA109236 (K.E.H.).

Presented in part at the 60th Annual Cancer Symposium of the Society of Surgical Oncology, March 15–18, 2007, Washington, DC, and at the American Society of Clinical Oncology Breast Symposium, September 7–8, 2007, San Francisco, CA.

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

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