Risk factors and racial and ethnic disparities in patients with breast cancer–related lymphedema Journal Article
| Authors: | Montagna, G.; Zhang, J.; Sevilimedu, V.; Charyn, J.; Abbate, K.; Gomez, E. A.; Mehrara, B.; Morrow, M.; Barrio, A. V. |
| Article Title: | Risk factors and racial and ethnic disparities in patients with breast cancer–related lymphedema |
| Abstract: | This cohort study evaluate rates and risk factors associated with breast cancer–related lymphedema in patients treated with axillary lymph node dissection. Key Points: Question: What are the lymphedema incidence and risk factors in a diverse cohort of women treated with axillary lymph node dissection and radiotherapy using defined measurement protocols? Findings: In this cohort study of 276 patients with breast cancer, the 24-month lymphedema rate was 23.8%, which differed based on race and ethnicity. Black race and Hispanic ethnicity had the greatest association with lymphedema development; neoadjuvant chemotherapy receipt, older age, and longer follow-up were also independently associated with lymphedema development. Meaning: Future studies should address the biologic mechanisms behind racial and ethnic disparities in lymphedema development to inform preventive strategies, and alternatives to neoadjuvant chemotherapy in patients with node-positive disease unlikely to downstage are necessary to minimize lymphedema risk. Importance: Risk factors for breast cancer–related lymphedema (BCRL) after axillary lymph node dissection (ALND) are poorly understood. Objective: To evaluate rates of and risk factors associated with BCRL in a prospective cohort of women treated with ALND. Design, Setting, and Participants: This prospective BCRL screening study performed at a tertiary cancer center enrolled women with breast cancer 18 years and older undergoing breast surgery and unilateral ALND in the primary setting or after sentinel lymph node biopsy. Exposures: Risk of BCRL during the first 2 years after ALND and radiotherapy. Main Outcomes and Measures: Patients were prospectively evaluated with arm volume (perometer) measurements, and BCRL was defined as a relative volume change of 10% or greater from baseline. Cumulative incidence of BCRL was assessed using competing risk analysis. Risk factors for BCRL were assessed on univariate and multivariable analyses. Results: From November 2016 to March 2020, 304 patients were enrolled; 276 had at least 1 longitudinal measurement. Median (IQR) age was 48 (40-57) years; median (IQR) body mass index, calculated as weight in kilograms divided by height in meters squared, was 26.4 (22.5-31.2). Of the 276 patients included in the analysis, 29 (11%) self-identified as Asian, 55 (20%) as Black, 16 (6%) as Hispanic, 166 (60%) as White, and 10 (3%) as unknown race and ethnicity; 70% received neoadjuvant chemotherapy (NAC); 93% received nodal irradiation. The 24-month BCRL rate was 23.8% (95% CI, 17.9%-29.8%), with significant variation by race and ethnicity (24-month rate: 37.2% [Black], 27.7% [Hispanic], 22.5% [Asian], and 19.8% [White]; P =.004). The BCRL rates were also higher among patients receiving NAC vs up-front surgery (24-month rate: 29.3% vs 11.1%; P =.01). On multivariable analysis, Black race and Hispanic ethnicity (compared with White race) (odds ratio [OR], 3.88; 95% CI, 2.14-7.08 and OR, 3.01; 95% CI, 1.10-7.62, respectively; P <.001 for each), receipt of NAC (compared with up-front surgery) (OR, 2.10; 95% CI, 1.16-3.95; P =.01), older age (OR, 1.04; 95% CI, 1.02-1.07 per 1-year increase; P =.001), and a longer follow-up interval (OR, 1.57; 95% CI, 1.30-1.90 per 6-month increase; P <.001) were independently associated with an increased risk of BCRL, while ERBB2-positive subtype was associated with a decreased risk of BCRL (compared with hormone receptor positive/ERBB2 negative): OR, 0.50; 95% CI, 0.23-0.99; P =.04). Conclusion and Relevance: In this cohort study, Black race, Hispanic ethnicity, NAC receipt, older age, and longer follow-up were independently associated with risk of BCRL. Studies are warranted to evaluate the biologic mechanisms behind racial and ethnic disparities in BCRL development and alternatives to NAC to avoid ALND in tumor subtypes unlikely to achieve nodal pathologic complete response. |
| Keywords: | sentinel lymph node; prospective studies; tertiary health care; ethnic groups; women's health; descriptive statistics; healthcare disparities; univariate statistics; breast neoplasms -- risk factors; lymphedema -- risk factors; human; race factors |
| Journal Title: | JAMA Oncology |
| Volume: | 8 |
| Issue: | 8 |
| ISSN: | 2374-2437 |
| Publisher: | American Medical Association |
| Date Published: | 2022-08-01 |
| Start Page: | 1195 |
| End Page: | 1200 |
| Language: | English |
| DOI: | 10.1001/jamaoncol.2022.1628 |
| PROVIDER: | EBSCOhost |
| PROVIDER: | cinahl |
| PMCID: | PMC9185510 |
| PUBMED: | 35679026 |
| DOI/URL: | |
| Notes: | Accession Number: 158627748 -- Entry Date: 20220830 -- Revision Date: 20220830 -- Publication Type: Article; research; tables/charts -- Journal Subset: Peer Reviewed; USA. -- Source: Cinahl |
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