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Breast Cancer Research

, 16:414

First Online: 22 August 2014Received: 08 March 2014Accepted: 17 July 2014DOI: 10.1186-s13058-014-0414-x

Cite this article as: Togawa, K., Ma, H., Sullivan-Halley, J. et al. Breast Cancer Res 2014 16: 414. doi:10.1186-s13058-014-0414-x

Abstract

IntroductionLymphedema is a potentially debilitating condition that occurs among breast cancer survivors. This study examines the incidence of self-reported lymphedema, timing of lymphedema onset, and associations between sociodemographic, clinical and lifestyle factors and lymphedema risk across racial-ethnic groups using data from a multicenter, multiethnic prospective cohort study of breast cancer survivors, the Health, Eating, Activity and Lifestyle Study.

MethodsA total of 666 women diagnosed with breast cancer staged as in situ, localized or regional disease at ages 35 to 64 years were recruited through the Surveillance, Epidemiology, and End Results registries in New Mexico non-Hispanic white and Hispanic white, Los Angeles County black, and Western Washington non-Hispanic white and followed for a median of 10.2 years. We evaluated sociodemographic factors, breast cancer- and treatment-related factors, comorbidities, body mass index BMI, hormonal factors, and lifestyle factors in relation to self-reported lymphedema by fitting Cox proportional hazards models, estimating hazard ratios HR and 95% confidence intervals CI.

ResultsOver the follow-up period, 190 women 29% reported lymphedema. The median time from breast cancer diagnosis to onset of lymphedema was 10.5 months range: 0.5 to 134.9 months. Factors independently associated with lymphedema were total-modified radical mastectomy versus partial-less than total mastectomy; HR = 1.37, 95% CI: 1.01 to 1.85, chemotherapy versus no chemotherapy; HR = 1.48, 95% CI: 1.09 to 2.02, no lymph nodes removed versus ≥10 lymph nodes removed; HR = 0.17, 95% CI: 0.08 to 0.33, pre-diagnostic BMI ≥30 kg-m versus BMI <25 kg-m; HR = 1.59, 95% CI: 1.09 to 2.31, and hypertension versus no hypertension; HR = 1.49, 95% CI: 1.06 to 2.10. After adjusting for demographics and breast cancer- and treatment-related factors, no significant difference in lymphedema risk was observed across racial-ethnic groups. Analyses stratified by race-ethnicity showed that hypertension and chemotherapy were lymphedema risk factors only for black women.

ConclusionsBreast cancer patients who have undergone extensive surgery or extensive lymph node dissection, or who have a higher BMI should be closely monitored for detection and treatment of lymphedema. Further studies are needed to understand the roles of chemotherapy and hypertension in the development of lymphedema.

AbbreviationsBMIbody mass index

CIconfidence interval

HEALHealth, Eating, Activity, and Lifestyle

HRhazard ratio

LALos Angeles county

LElymphedema

METmetabolic equivalent task

NMNew Mexico

NOSnot otherwise specified

SEERsurveillance, epidemiology, and end results

WWWestern Washington

Electronic supplementary materialThe online version of this article doi:10.1186-s13058-014-0414-x contains supplementary material, which is available to authorized users.

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Autor: Kayo Togawa - Huiyan Ma - Jane Sullivan-Halley - Marian L Neuhouser - Ikuyo Imayama - Kathy B Baumgartner - Ashley Wilder

Fuente: https://link.springer.com/



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