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Breast Cancer Res Treat. 2016 Aug;159(1):119-29. doi: 10.1007/s10549-016-3913-x. Epub 2016 Jul 22.

Race/ethnicity, genetic ancestry, and breast cancer-related lymphedema in the Pathways Study.

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Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA.
Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, 14263, NY, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, 94612, USA.
San Jose Medical Center, Kaiser Permanente Northern California, San Jose, 95119, CA, USA.


Breast cancer-related lymphedema (BCRL) is a serious chronic condition after breast cancer (BC) surgery and treatment. It is unclear if BCRL risk varies by race/ethnicity. In a multiethnic prospective cohort study of 2953 BC patients, we examined the association of self-reported BCRL status with self-reported race/ethnicity and estimated genetic ancestry. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated by multivariable Cox proportional hazards models, with follow-up starting 6 months post-BC diagnosis. Estimates were further stratified by body mass index (BMI). By 48 months of follow-up, 342 (11.6 %) women reported having BCRL. Younger age at BC diagnosis, higher BMI at baseline, and lower physical activity were associated with greater BCRL risk. African American (AA) women had a 2-fold increased risk of BCRL compared with White women (HR = 2.04; 95 % CI 1.35-3.08). African genetic ancestry was also associated with an increased risk (HR = 2.50; 95 % CI 1.43, 4.36). Both risks were attenuated but remained elevated after adjusting for known risk factors and became more pronounced when restricted to the nonobese women (adjusted HR = 2.31 for AA and HR = 3.70 for African ancestry, both p < 0.05). There was also evidence of increased BCRL risk with Hispanic ethnicity in the nonobese women. Nonobese AA women had a higher risk of BCRL than White women, which cannot be fully explained by known risk factors. This is the first large-scale, prospective study demonstrating differences in BCRL risk according to race/ethnicity as assessed by both self-report and genetic ancestry data, with a potential ancestry-obesity interaction.


Ancestry; Breast cancer-related lymphedema; Genetics; Interaction; Obesity; Racial disparity

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