The risk of developing arm lymphedema among breast cancer survivors: A meta-analysis of treatment factors

Rebecca J. Tsai, Leslie K Dennis, Charles F. Lynch, Linda G. Snetselaar, Gideon K D Zamba, Carol Scott-Conner

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

Background: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent. Methods: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis. Random-effect models were used to estimate the pooled risk ratio. Results: The authors identified 98 independent studies that reported at least one risk factor of interest. The risk ratio (RR) of arm lymphedema was increased after mastectomy when compared with lumpectomy [RR = 1.42; 95% confidence interval (CI) 1.15-1.76], axillary dissection compared with no axillary dissection (RR = 3.47; 95% CI 2.34-5.15), axillary dissection compared with sentinel node biopsy (RR = 3.07; 95% CI 2.20-4.29), radiation therapy (RR = 1.92; 95% CI 1.61-2.28), and positive axillary nodes (RR = 1.54; 95% CI 1.32-1.80). These associations held when studies using self-reported lymphedema were excluded. Conclusions: Mastectomy, extent of axillary dissection, radiation therapy, and presence of positive nodes increased risk of developing arm lymphedema after breast cancer. These factors likely reflected lymph node removal, which most surgeons consider to be the largest risk factor for lymphedema. Future studies should consider examining sentinel node biopsy versus no dissection with a long follow-up time post surgery to see if there is a benefit of decreased lymphedema compared with no dissection.

Original languageEnglish (US)
Pages (from-to)1959-1972
Number of pages14
JournalAnnals of Surgical Oncology
Volume16
Issue number7
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Lymphedema
Survivors
Meta-Analysis
Odds Ratio
Dissection
Confidence Intervals
Mastectomy
Therapeutics
Radiotherapy
Breast Neoplasms
Biopsy
Segmental Mastectomy
Breast Cancer Lymphedema
PubMed
Lymph Nodes
Quality of Life

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The risk of developing arm lymphedema among breast cancer survivors : A meta-analysis of treatment factors. / Tsai, Rebecca J.; Dennis, Leslie K; Lynch, Charles F.; Snetselaar, Linda G.; Zamba, Gideon K D; Scott-Conner, Carol.

In: Annals of Surgical Oncology, Vol. 16, No. 7, 07.2009, p. 1959-1972.

Research output: Contribution to journalArticle

Tsai, Rebecca J. ; Dennis, Leslie K ; Lynch, Charles F. ; Snetselaar, Linda G. ; Zamba, Gideon K D ; Scott-Conner, Carol. / The risk of developing arm lymphedema among breast cancer survivors : A meta-analysis of treatment factors. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 7. pp. 1959-1972.
@article{fa7d8f6b1422424694e0bc3d5c82bd2e,
title = "The risk of developing arm lymphedema among breast cancer survivors: A meta-analysis of treatment factors",
abstract = "Background: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent. Methods: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis. Random-effect models were used to estimate the pooled risk ratio. Results: The authors identified 98 independent studies that reported at least one risk factor of interest. The risk ratio (RR) of arm lymphedema was increased after mastectomy when compared with lumpectomy [RR = 1.42; 95{\%} confidence interval (CI) 1.15-1.76], axillary dissection compared with no axillary dissection (RR = 3.47; 95{\%} CI 2.34-5.15), axillary dissection compared with sentinel node biopsy (RR = 3.07; 95{\%} CI 2.20-4.29), radiation therapy (RR = 1.92; 95{\%} CI 1.61-2.28), and positive axillary nodes (RR = 1.54; 95{\%} CI 1.32-1.80). These associations held when studies using self-reported lymphedema were excluded. Conclusions: Mastectomy, extent of axillary dissection, radiation therapy, and presence of positive nodes increased risk of developing arm lymphedema after breast cancer. These factors likely reflected lymph node removal, which most surgeons consider to be the largest risk factor for lymphedema. Future studies should consider examining sentinel node biopsy versus no dissection with a long follow-up time post surgery to see if there is a benefit of decreased lymphedema compared with no dissection.",
author = "Tsai, {Rebecca J.} and Dennis, {Leslie K} and Lynch, {Charles F.} and Snetselaar, {Linda G.} and Zamba, {Gideon K D} and Carol Scott-Conner",
year = "2009",
month = "7",
doi = "10.1245/s10434-009-0452-2",
language = "English (US)",
volume = "16",
pages = "1959--1972",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - The risk of developing arm lymphedema among breast cancer survivors

T2 - A meta-analysis of treatment factors

AU - Tsai, Rebecca J.

AU - Dennis, Leslie K

AU - Lynch, Charles F.

AU - Snetselaar, Linda G.

AU - Zamba, Gideon K D

AU - Scott-Conner, Carol

PY - 2009/7

Y1 - 2009/7

N2 - Background: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent. Methods: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis. Random-effect models were used to estimate the pooled risk ratio. Results: The authors identified 98 independent studies that reported at least one risk factor of interest. The risk ratio (RR) of arm lymphedema was increased after mastectomy when compared with lumpectomy [RR = 1.42; 95% confidence interval (CI) 1.15-1.76], axillary dissection compared with no axillary dissection (RR = 3.47; 95% CI 2.34-5.15), axillary dissection compared with sentinel node biopsy (RR = 3.07; 95% CI 2.20-4.29), radiation therapy (RR = 1.92; 95% CI 1.61-2.28), and positive axillary nodes (RR = 1.54; 95% CI 1.32-1.80). These associations held when studies using self-reported lymphedema were excluded. Conclusions: Mastectomy, extent of axillary dissection, radiation therapy, and presence of positive nodes increased risk of developing arm lymphedema after breast cancer. These factors likely reflected lymph node removal, which most surgeons consider to be the largest risk factor for lymphedema. Future studies should consider examining sentinel node biopsy versus no dissection with a long follow-up time post surgery to see if there is a benefit of decreased lymphedema compared with no dissection.

AB - Background: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent. Methods: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis. Random-effect models were used to estimate the pooled risk ratio. Results: The authors identified 98 independent studies that reported at least one risk factor of interest. The risk ratio (RR) of arm lymphedema was increased after mastectomy when compared with lumpectomy [RR = 1.42; 95% confidence interval (CI) 1.15-1.76], axillary dissection compared with no axillary dissection (RR = 3.47; 95% CI 2.34-5.15), axillary dissection compared with sentinel node biopsy (RR = 3.07; 95% CI 2.20-4.29), radiation therapy (RR = 1.92; 95% CI 1.61-2.28), and positive axillary nodes (RR = 1.54; 95% CI 1.32-1.80). These associations held when studies using self-reported lymphedema were excluded. Conclusions: Mastectomy, extent of axillary dissection, radiation therapy, and presence of positive nodes increased risk of developing arm lymphedema after breast cancer. These factors likely reflected lymph node removal, which most surgeons consider to be the largest risk factor for lymphedema. Future studies should consider examining sentinel node biopsy versus no dissection with a long follow-up time post surgery to see if there is a benefit of decreased lymphedema compared with no dissection.

UR - http://www.scopus.com/inward/record.url?scp=67649210593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649210593&partnerID=8YFLogxK

U2 - 10.1245/s10434-009-0452-2

DO - 10.1245/s10434-009-0452-2

M3 - Article

C2 - 19365624

AN - SCOPUS:67649210593

VL - 16

SP - 1959

EP - 1972

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 7

ER -