Potential Risk Activities and Breast Cancer–Related Lymphedema in Patients Undergoing Bilateral Surgery

Key Points

  • Among women undergoing bilateral breast cancer surgery, no association was found between lymphedema risk and blood draws, injections, blood pressure readings, trauma to the at-risk arm, or number or duration of air flights.
  • Body mass index, axillary node dissection, and receipt of adjuvant chemotherapy were associated with an increased risk for lymphedema. 

In a study reported in the Journal of Clinical Oncology, Asdourian et al found that several factors considered to pose an increased risk of lymphedema were not significantly associated with the occurrence of lymphedema among women undergoing bilateral breast cancer surgery.

Study Details

In the study, 327 patients undergoing bilateral surgery between 2013 and 2016 at Massachusetts General Hospital were prospectively screened for arm lymphedema defined as weight-adjusted volume change ≥ 10% from baseline. Arm perometry and patient-reported data were collected preoperatively and at regular intervals thereafter; patients completed risk assessment surveys reporting potential risk factors, including blood draws, injections, blood pressure readings, trauma to the at-risk arm, and number of air flights since the previous measurement.

Risk Factors

Of 654 at-risk arms, lymphedema developed in 83 over postoperative follow-up ranging from 6.1 to 68.2 months. On univariate analysis, no significant associations were observed between lymphedema risk and any vs no blood draws (P = .4906), any vs no injections (P = .0928), any incident of vs no trauma to at-risk arms (P = .5705), or any flights vs no flights (P = .2756) or any duration of flights vs no flights (P = .5223 for 1–12 hours; P = .2524 for > 12 hours); none of these factors was significant on a multivariate analysis. Having at least one vs no blood pressure measurements was a significant factor for decreased weight-adjusted volume change on univariate analysis (P = .0109) but not on multivariate analysis.

On multivariate analysis, factors associated with an increased risk were body mass index ≥ 25 kg/m2 at breast cancer diagnosis (P = .0404), receipt of axillary lymph node dissection (P = .0464), and receipt of adjuvant chemotherapy (P = .0161).

The investigators concluded: “Blood pressure readings, blood draws, injections, and number or duration of flights were not significantly associated with increases in arm volume in this cohort. These findings may help to guide patient education about lymphedema risk reduction strategies for those who undergo bilateral breast cancer surgery.”

The study was supported by National Cancer Institute grants and the Adele McKinnon Research Fund for Breast Cancer-Related Lymphedema.

Alphonse G. Taghian, MD, PhD, of the Department of Radiation Oncology, Massachusetts General Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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