Lymphedema: Estimating the Risk for Patients with Breast Cancer

Breast cancer awareness
Breast cancer awareness (Photo credit: AslanMedia)

The development of breast cancer-related lymphedema is tied closely to how many nodes are removed by surgery. Radiation therapy and chemotherapy can also increase risk. A recent study from Korea (published in (check out the length of the this name!) International Journal of Radiation Oncology Biology Physics, 2013) attempted to estimate the risk of lympededema based on combinations of these treatment factors.

The Study: The authors looked at 772 patients with breast cancer. All had primary surgery with axillary node dissection from 2004 to 2009. The study looked back at these patients (retrospective analysis). Adjuvant chemotherapy was given to 677 patients. Of the 675 who got radiation therapy, 35% had a component directed at the nodes above the collarbone (supraclavicular nodes).

Results: Half of patients were followed beyond 5.1 years. The 5 year cumulative chance of getting edema was 17%. Of these 76% developed it in the first 2 years after surgery. Fully 91% of those who got it did so within 3 years.

Risk factors included number of nodes removed by the surgeon, chemotherapy use, and whether the nodes above the collarbone were treated with radiation therapy. The total number of risk factors correlated well with the incidence of lymphedema. Patients with 0 to 1 risk factors had a 5 year risk of only 3%, while those with 2 or 3 risk factors had a risk of 19% and 38%, respectively.

My take: The bad news? Any lymph node removal introduces risk. The good news? If a patient had 10 of fewer nodes removed, and no other risk factors, the 5 year risk dropped to 1.4%. For those who had fewer than 10 nodes removed but got chemotherapy, the risk was 3.8%. Fortunately today, many patients who have a limited node sampling of only 1 to 3 nodes (to help establish prognosis for invasive breast cancer) have a very low risk of significant lymphedema. The so-called sentinel node procedure has truly improved the surgical management for many patients with early breast cancer. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

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6 thoughts on “Lymphedema: Estimating the Risk for Patients with Breast Cancer”

  1. Helen , incredible how you keep coming up with interesting info. You should make this your full-time job (it is probably already)…cus you provide us with update info and personal stories that is trustworthy ! can i donate somewhere 😉 so you can continue untill there is a cure? 🙂
    this text is interesting…and it shows also that the less nodes removed the less damafe. there are however people that do develop le after sentinel node biopsy and i guess that those are people like me…lymfescintography showed that i have only few nodes …like 4 or something like that at my arms and legs…however there are only visible signs of le in one leg. but i can imagine that even when i belonged to the group ‘less then 10 nodes removed’ – i would end up with huuuug problems, since that would mean they took them alll….
    gives a good insight…and waiting for artificial nodes or growth factor. they should even invest more money in le cure research…We need a famous person putting their shoulders undr it like a foster parent … anyone? tips? we should lobby for this so that march 2014 finally le awareness is everywhere!!!

  2. I think a better way to judge risk would be how many nodes remain rather than how many were taken. I think the range for the axillary is 5 to 35 with most people being in the 20s. They took all mine and it turned out I had 6.
    I think it is good that they are looking at targeted areas in radiation, not just whether there was radiation. It does make a difference the range of area, how intense the radiation, and what they are targeting.

    1. Elizabeth, thank you for your comments. I think the challenge is that, absent doing a very invasive complete axillary dissection (with potential significant morbidity), we do not know how many nodes any particular individual has. Fortunately, the historic trend has been to the removal of fewer and fewer axillary nodes, on average. I have no doubt that the number will someday be zero. Wishing you all the best, Michael.

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