In a prospective single-institution study reported in JAMA Oncology, Giacomo Montagna, MD, MPH, and colleagues found that the risk for breast cancer–related lymphedema after axillary lymph node dissection was increased in Black and Hispanic patients, those who received neoadjuvant chemotherapy, and those with a longer interval between surgery and last follow-up.
Giacomo Montagna, MD, MPH
Study Details
The breast cancer–related lymphedema screening study included 276 evaluable women undergoing breast surgery and unilateral axillary lymph node dissection in the primary setting or after sentinel lymph node biopsy enrolled at Memorial Sloan Kettering Cancer Center between November 2016 and March 2020. Patients underwent arm volume (perometer) measurements, with breast cancer–related lymphedema defined as a relative volume change of ≥ 10% from baseline.
Overall, 29 patients (11%) were Asian, 55 (20%) were Black, 16 (6%) were Hispanic, 166 (60%) were White, and 10 (3%) were of unknown race/ethnicity. A total of 70% received neoadjuvant chemotherapy and 93% received nodal irradiation.
The primary outcome measure was risk of breast cancer–related lymphedema during the first 24 months after axillary lymph node dissection and radiotherapy.
Key Findings
Median follow-up was 22.6 months, with 88% of the cohort having ≥ 12 months of follow-up. The 24-month breast cancer–related lymphedema rate in the total cohort was 23.8% (95% confidence interval [CI] = 17.9%–29.8%), with rates of 37.2% in Black women, 27.7% in Hispanic women, 22.5% in Asian women, and 19.8% in White women (overall P = .004). Rates were 29.3% among women receiving neoadjuvant chemotherapy vs 11.1% among those receiving upfront surgery (P = .01).
On multivariate analysis, factors associated with increased risk were:
- Black race (odds ratio [OR] = 3.88, 95% CI = 2.14–7.08, P < .001) and Hispanic ethnicity (OR = 3.01, 95% CI = 1.10–7.62, P < .001) vs White race
- Receipt of neoadjuvant chemotherapy vs upfront surgery (OR = 2.10, 95% CI = 1.16–3.95, P = .01)
- Older age (OR per 1-year increase = 1.04, 95% CI = 1.02–1.07, P = .001)
- Longer interval from surgery to last follow-up (OR per 6-month increase = 1.57, 95% CI = 1.30–1.90, P < .001).
HER2-positive disease was associated with reduced risk vs hormone receptor–positive, HER2-negative disease (OR = 0.50, 95% CI = 0.23–0.99, P = .04).
The investigators concluded, “In this cohort study, Black race, Hispanic ethnicity, receipt [of neoadjuvant chemotherapy], older age, and longer follow-up were independently associated with risk of breast cancer–related lymphedema. Studies are warranted to evaluate the biologic mechanisms behind racial and ethnic disparities in breast cancer–related lymphedema development and alternatives to neoadjuvant chemotherapy to avoid axillary lymph node dissection in tumor subtypes unlikely to achieve nodal pathologic complete response.”
Andrea V. Barrio, MD, of the Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the National Cancer Institute, Chanel Survivorship Endowment, and Manhasset Women’s Coalition Against Breast Cancer. For full disclosures of the study authors, visit jamanetwork.com.
