Racial and ethnic differences in breast inflammation and its association with lymphedema risk after axillary lymph node dissection Journal Article
| Authors: | Roberts, A.; Campbell, A. C.; Pollack, B. L.; Montagna, G.; Sevilimedu, V.; Axelrod, B.; Gomez, E. A.; Giri, D.; Morrow, M.; Mehrara, B. J.; Barrio, A. V. |
| Article Title: | Racial and ethnic differences in breast inflammation and its association with lymphedema risk after axillary lymph node dissection |
| Abstract: | Background: Chronic inflammatory responses initiated by lymphatic injury play a key role in the pathophysiology of secondary lymphedema; however, it is unknown if these responses vary by race/ethnicity. We assessed whether baseline differences in inflammation, characterized by crown-like structures of the breast (CLS-B), contributed to lymphedema risk in a diverse cohort of patients treated with axillary lymph node dissection (ALND). Methods: Between 11/2016-03/2020, patients undergoing ALND were enrolled in a prospective lymphedema screening study. Race/ethnicity were self-reported. BMI and volumetric arm measurements were performed at baseline and biannually. Breast tissue was assessed for CLS-B utilizing a CD-68 IHC stain in non-tumor tissue. Lymphedema incidence was assessed using competing-risk analysis and compared between patients with and without CLS-B. Results: Of 281 patients included, 11% self-identified as Asian, 20% Black, 8% Hispanic, 58% White, and 3% unknown. Median BMI was 26.3kg/m2; median follow-up was 2.99 years. Overall, 54% had CLS-B; prevalence varied by BMI (36% [BMI < 25], 63% [BMI 25-30], 70% [BMI > 30], p < 0.001) and by race/ethnicity (68% Black/64% Hispanic vs. 59% Asian/46% White, p = 0.02). The 2-year lymphedema rate was higher among Black and Hispanic women (32% Black/27% Hispanic versus 15% Asian/17% White, p =.012), and among women with CLS-B (27% vs. 12% [no CLS-B], p = 0.03). On multivariable analysis, Black race (p = 0.009), neoadjuvant chemotherapy receipt (p = 0.024), and older age (p = 0.002) were independently associated with lymphedema development, while CLS-B was not (p = 0.3). Conclusion: The higher CLS-B prevalence observed in Black women suggests an increased propensity for inflammation, although its role in lymphedema development remains uncertain. © Society of Surgical Oncology 2025. |
| Keywords: | adult; controlled study; human tissue; major clinical study; follow up; antineoplastic agent; disease association; breast cancer; mastectomy; epidermal growth factor receptor 2; inflammation; cohort analysis; risk assessment; lymphedema; body mass; neoadjuvant chemotherapy; ethnic difference; hormone receptor; mastitis; race difference; african american; caucasian; hispanic; axillary lymph node dissection; cd68 antigen; asian; breast-conserving surgery; disparities; invasive breast cancer; human; female; article; breast tissue; breast cancer-related lymphedema; crown-like structures of the breast |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 32 |
| Issue: | 5 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2025-05-01 |
| Start Page: | 3309 |
| End Page: | 3316 |
| Language: | English |
| DOI: | 10.1245/s10434-025-16977-8 |
| PUBMED: | 39971857 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Andrea V. Barrio -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work