The Risk of Developing Arm Lymphedema Among Breast Cancer Survivors: A Meta-Analysis of Treatment Factors
Top Cited Papers
- 14 April 2009
- journal article
- research article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 16 (7), 1959-1972
- https://doi.org/10.1245/s10434-009-0452-2
Abstract
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. 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. 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. 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.Keywords
This publication has 86 references indexed in Scilit:
- Cancer Statistics, 2008CA: A Cancer Journal for Clinicians, 2008
- Lymphedema in breast cancer survivors: Assessment and information provision in a specialized breast unitPatient Education and Counseling, 2007
- Morbidity of Sentinel Lymph Node Biopsy (SLN) Alone Versus SLN and Completion Axillary Lymph Node Dissection After Breast Cancer SurgeryAnnals of Surgery, 2007
- Randomized Multicenter Trial of Sentinel Node Biopsy Versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC TrialJNCI Journal of the National Cancer Institute, 2006
- Comparison of morbidity between axillary lymph node dissection and sentinel node biopsyEuropean Journal of Surgical Oncology, 2003
- LymphoedemaNursing Standard, 2003
- Relapse and Morbidity in Patients Undergoing Sentinel Lymph Node Biopsy Alone or With Axillary Dissection for Breast CancerArchives of Surgery, 2003
- Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage i. results from a randomised trialEuropean Journal of Cancer, 1997
- Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiationBreast Cancer Research and Treatment, 1992
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986