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Breast. 2016 Aug;28:29-36. doi: 10.1016/j.breast.2016.04.011. Epub 2016 May 13.

Risk factors for lymphoedema in women with breast cancer: A large prospective cohort.

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Faculty of Health Sciences, University of Sydney, Sydney, Australia. Electronic address:
Faculty of Health Sciences, University of Sydney, Sydney, Australia.
Chris O'Brien Lifehouse, Camperdown, Australia.
Faculty of Health Sciences, University of Sydney, Sydney, Australia; School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.
Royal Brisbane and Women's Hospital, School of Medicine, The University of Queensland, Brisbane, Australia.
Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia.


A prospective study was conducted to identify women at increased risk for lymphoedema (LE) based on axillary surgery. Assessment occurred prior to surgery, within 4 weeks, and at 6, 12 and 18 months following surgery. Following post-surgery assessment, women were asked to complete weekly diaries regarding events that occurred in the previous week. Risk factors were grouped into demographic, lifestyle, breast cancer treatment-related, arm swelling-related, and post-surgical activities. Bioimpedance spectroscopy thresholds were used to determine presence of LE. At 18-months, 241 women with <5 nodes removed and 209 women with ≥5 nodes removed were assessed. For those with <5 nodes removed, LE was present in 3.3% compared with 18.2% for those with ≥5 nodes removed. There were insufficient events to identify risk factors for those with <5 nodes removed; for those with >5 nodes removed, independent risk factors included presence of arm swelling at 12-months (Odds Ratio (OR): 13.5, 95% CI 4.8, 38.1; P < 0.01), at 6-months (5.6 (2.0, 16.9); P < 0.01), and radiotherapy to the axilla (2.6 (0.7, 8.9); P = 0.14). Arm swelling at 6 and 12 months was associated with taxane-based chemotherapy, high body weight at diagnosis and arm swelling within 4 weeks post-surgery. Of the post-surgical events assessed in a sub-group of women with >5 nodes removed and who maintained weekly diaries, only blood drawn from the 'at-risk' arm was identified as a potential risk (OR 2.0; 0.8, 5.2). For women with ≥5 nodes removed, arm swelling in the first year poses a very strong risk for presence of LE at 18-months.


Air travel; Arm swelling; Axillary lymph node dissection; Blood pressure; Exercise; Needle punctures

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