A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Breast Cancer Women

BACKGROUND: We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients. METHODS: Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries. RESULTS: Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were the removal of more than five lymph nodes (OR 4.68-5.61, 95% CI: 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for > 15 nodes) and the presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24). CONCLUSIONS: Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors have self-reported lymphedema. In this group of predominately community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.