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QJM Advance Access published online on April 8, 2005
QJM, doi:10.1093/qjmed/hci053
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received September 23, 2004
Revised February 18, 2005

Original papers

Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study

B. Clark 1, J. Sitzia 1*, and W. Harlow 1

1 Worthing and Southlands Hospitals NHS Trust, Worthing Hospital, UK

* To whom correspondence should be addressed.
J. Sitzia, E-mail: John.Sitzia{at}wash.nhs.uk


  Abstract

Background: Breast-cancer-related lymphoedema is a chronic condition with estimates of incidence ranging from 6 to 83%. Lymphoedema has been associated with a variety of risk factors. However, this evidence has suffered from methodological weaknesses, and so has had little impact upon clinical practice.

Aim: To examine incidence and risk factors [hospital skin puncture, surgical procedure, Body Mass Index (BMI), age, axillary node status, number of axillary nodes removed, radiotherapy and surgery on dominant side] for breast cancer-related arm lymphoedema.

Design: Prospective observational study, with measurement of limbs pre-operatively and at regular intervals post-operatively.

Methods: We recruited 251 women who had surgical treatment for breast cancer that involved sampling, excision or biopsy of axillary nodes, aged ≥!!18 years, and free of advanced disease and psychological co-morbidities. Of these, 188 (74.9%) were available for 3-year follow-up.

Results: At follow-up, 39 (20.7%) had developed lymphoedema. Hospital skin puncture (vs. none) (RR 2.44, 95%CI 1.33-4.47), mastectomy (vs. wide local excision or lumpectomy) (RR 2.04, 95%CI 1.18-3.54), and BMI≥26 (vs. BMI 19-26) (RR 2.02, 95%CI 1.11-3.68) were the only significant risk factors.

Discussion: Lymphoedema remains a significant clinical problem, with 1:5 women in this sample developing the condition following treatment for breast cancer. Risk factors are identified in the development of lymphoedema that should be taken into account in clinical practice.


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