Incidence of lymphedema thirty to sixty months after breast cancer surgery.

Abstract

e19520 Background: Breast cancer (BC) survivors are at lifetime risk for developing lymphedema (LE), although the majority of the literature does not report incidence and prevalence beyond short-term follow-up. Utilizing a prospective study design with baseline measurements occurring before surgery for BC, the goal of this research was to describe LE occurrence 5 years after surgery. Methods: Participants were enrolled following diagnosis of BC but before surgery and followed every 3 months for 12 months, then every 6 months thereafter (through 60 months, N = 211). Limb volume changes (LVC) were measured using: (a) circumferences at 4 cm intervals, (b) perometry, and (c) symptom experience (SS) via interview. Four diagnostic criteria for LE were used: (i) 2 cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) report of limb heaviness/swelling, “now” or “in the past year.” Additionally, the objective measures (criteria i-iii) were applied either: ipsilateral limb versus contralateral limb at a given visit, or ipsilateral limb at a given visit versus ipsilateral limb pre-surgery. Results: At 5 years post-surgery, LE occurrence in this cohort of BC survivors ranged between 43-94%, compared to 38-87% at 2.5 years, based on the criteria used in this analysis. When compared to data at 2.5 years, the most liberal method at 5 years to identify LE in this preliminary analysis was 2 cm circumferential change (87% vs. 94%), followed by 200 mL LVC (65% vs. 83%), 10% LVC (40% vs. 53%), and self-reporting of heaviness/swelling (38% vs. 43%). In this cohort, mean time to LE diagnosis ranged from 15-40 months based on the various criterions, with 2 cm the shortest and report of heaviness/swelling the longest. Conclusions: This updated analysis suggests breast cancer survivors continued to be at risk for the development of LE, as demonstrated by an increase of LE occurrence between 2.5 to 5 years for all criteria applied. From 2.5 to 5 years, 200 mL LVC becomes the criteria to most commonly identify LE, whereas 2 cm was the most common criteria from baseline to 2.5 years. No significant financial relationships to disclose.