Systemic Analysis on Risk Factors for Breast Cancer Related Lymphedema

  • Zhu, Ya-Qun (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University) ;
  • Xie, Yu-Huan (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University) ;
  • Liu, Feng-Huan (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University) ;
  • Guo, Qi (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University) ;
  • Shen, Pei-Pei (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University) ;
  • Tian, Ye (Department of Radiotherapy & Oncology, The Second Affiliated Hospital of Soochow University)
  • Published : 2014.08.30


Background: To evaluate risk factors for upper extremity lymphedema due to breast cancer surgery. Materials and Methods: Clinical studies published on PubMed, Ovid, EMbase, and Cochrane Library from January 1996 to December 2012 were selected. Results: Twenty-five studies were identified, including 12,104 patients. Six risk factors related to the incidence of lymphedema after breast cancer treatment were detected: axillary lymph node dissection (OR=3.73, 95%CI 1.16 to 11.96), postoperative complications (OR=2.64, 95%CI 1.10 to 6.30), hypertension (OR=1.83, 95%CI 1.38 to 2.42), high body mass index (OR=1.80, 95%CI 1.30 to 2.49), chemotherapy (OR=1.38, 95%CI 1.07 to 1.79) and radiotherapy (OR=1.35, 95%CI 1.10 to 1.66). We found significant protective factors for lymphedema: pathologic T classification (OR=0.57, 95%CI 0.36 to 0.91) and stage (OR=0.60, 95%CI 0.39 to 0.93), while some factors, like age, number of positive lymph nodes, number of lymph node dissection, demonstrated no obvious correlation. Conclusions: Axillary lymph node dissection, postoperative complications, hypertension, body mass index, chemotherapy, radiotherapy are risk factors for lymphedema after breast cancer treatment. Attention should be paid to patients with risk factors to prevent the occurrence of lymphedema.


  1. Alipour S, Hadji M, Hosseini L, et al (2014). Levels of serum 25-hydroxy-vitamin D in benign and malignant breast masses. Asian Pac J Cancer Prev, 15, 129-32.
  2. Avci IA, Kumcagiz H, Altinel B, et al (2014). Turkish female academician self-esteem and health beliefs for breast cancer screening. Asian Pac J Cancer Prev, 15, 155-60.
  3. Armer J, Fu MR (2005). Age differences in post-breast cancer lymphedema signs and symptoms. Cancer Nurs, 28, 200- 7; 208-9.
  4. Baron RH, Fey JV, Raboy S, et al. (2002). Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection. Oncol Nurs Forumv, 29, 651-9.
  5. Boonlikit S (2013). Comparison of mammography in combination with breast ultrasonography versus mammography alone for breast cancer screening in asymptomatic women. Asian Pac J Cancer Prev, 14, 7731-6.
  6. Cabuk D, Basaran G, Teomete M, et al (2014). Clinical outcome of Turkish metastatic breast cancer patients with currently available treatment modalities--single center experience. Asian Pac J Cancer Prev, 15, 117-22.
  7. Cheville AL, McGarvey CL, Petrek JA, et al (2003). The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol, 13, 214-25.
  8. Clark B, Sitzia J, Harlow W. (2005). Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM, 98, 343-8.
  9. Clough-Gorr KM, Ganz PA, Silliman RA (2010). Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of followup. Breast J, 16, 147-55.
  10. CardA, CrosbyMA, Liu J, et al (2012). Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg, 130, 1169-78.
  11. Deo SV, Ray S, Rath GK, et al (2004). Prevalence and risk factors for development of lymphedema following breast cancer treatment. Indian J Cancer, 41, 8-12.
  12. Egger M, Schneider M, Davey Smith G (1998). Spurious precision? Meta-analysis of observational studies. BMJ, 316, 140-4.
  13. Egger M, Davey Smith G, Schneider M, et al (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315, 629-34.
  14. El Sharkawi FZ, El Shemy HA, Khaled HM (2014). Possible anticancer activity of rosuvastatine, doxazosin, repaglinide and oxcarbazepin. Asian Pac J Cancer Prev, 15, 199-203.
  15. Engel J, Kerr J, Schlesinger-Raab A, et al (2003). Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Res Treat, 79, 47-57.
  16. Fouladi N, Ali-Mohammadi H, Pourfarzi F, et al (2014). Exploratory study of factors affecting continuity of cancer care: Iranian Women's perceptions. Asian Pac J Cancer Prev, 15, 133-7.
  17. Francis WP, Abghari P, Du W, et al (2006). Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection. American J Surgery, 192, 636-9.
  18. Gang M, Kim JI, Oh KO, et al (2013). Factors associated with mammography adherence among married Chinese women in Yanbian, China. Asian Pac J Cancer Prev, 14, 7207-13.
  19. Geller BM, Vacek PM, O'Brien P, et al (2003). Factors associated with arm swelling after breast cancer surgery (J). J Womens Health (Larchmt), 12, 921-30.
  20. Graham P, Jagavkar R, Browne L, et al (2006). Supraclavicular radiotherapy must be limited laterally by the coracoid to avoid significant adjuvant breast nodal radiotherapy lymphoedema risk. Australas Radiol, 50, 578-82.
  21. Goffman TE, Laronga C, Wilson L, et al (2004). Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J, 10, 405-11.
  22. Hayes SC, Johansson K, Stout NL, et al (2012). Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer, 118, 2237-49.
  23. Heiney SP, McWayne J, Cunningham JE, et al (2007). Quality of life and lymphedema following breast cancer. Lymphology, 40, 177-84.
  24. Herd-Smith A, Russo A, Muraca MG, et al (2001). Prognostic factors for lymphedema after primary treatment of breast carcinoma. Cancer, 92, 1783-7.<1783::AID-CNCR1694>3.0.CO;2-G
  25. Hinrichs CS, Watroba NL, Rezaishiraz H, et al (2004). Lymphedema secondary to postmastectomy radiation:incidence and risk factors. Ann Surg Oncol, 11, 573-80.
  26. Hayes S, Cornish B, Newman B (2005). Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat, 89, 221-6.
  27. Hayes SC, Janda M, Cornish B, et al (2008). Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol, 26, 3536-42.
  28. Haddad P, Farzin M, Amouzegar-Hashemi F, et al (2010). A multicentre cross-sectional study of arm lymphedema four or more years after breast cancer treatment in Iranian patients. Breast Cancer, 17, 281-5.
  29. Hu Q, Luo Z, Xu T, et al (2014). FOXA1: a promising prognostic marker in breast cancer. Asian Pac J Cancer Prev, 15, 11-6.
  30. Kiel KD, Rademacker AW (1996). Early-stage breast cancer: arm edema after wide excision and breast irradiation. Radiology, 198, 279-83.
  31. Kocak Z, Overgaard J (2000). Risk factors of arm lymphedema in breast cancer patients. Acta Oncol, 39, 389-92.
  32. Kochhar AK, Jindal U, Singh K (2013). Spectrum of cytological findings in fine needle aspiration cytology of breast lumps with histopathology correlation: experience in a tertiary care rural hospital in India. Asian Pac J Cancer Prev, 14, 7257-60.
  33. Lee SH, Min YS, Park HY, et al (2012). Health-related quality of life in breast cancer patients with lymphedema who survived more than one year after surgery. J Breast Cancer, 15, 449-53.
  34. McCredie MR, Dite GS, Porter L, et al (2001). Prevalence of self-reported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast, 10, 515-22.
  35. McLaughlin SA, Wright MJ, Morris KT, et al (2008). Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol, 26, 5213-9.
  36. Mak SS, Yeo W, Lee YM, et al (2008). Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res, 57, 416-25.
  37. Meeske KA, Sullivan-Halley J, Smith AW, et al (2009). Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat, 113 , 383-91.
  38. Meiyanto E, Putri DD, Susidarti RA, et al (2014). Curcumin and its analogues (PGV-0 and PGV-1) enhance sensitivity of resistant MCF-7 cells to doxorubicin through inhibition of HER2 and NF-kB activation. Asian Pac J Cancer Prev, 15, 179-84.
  39. Mohammadi S, Sulaiman S, Koon PB, et al (2013). Association of nutritional status with quality of life in breast cancer survivors. Asian Pac J Cancer Prev, 14, 7749-55.
  40. Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. American Journal of Surgery, 2004, 187, 69-72.
  41. Ozkan-Gurdal S, Cabioglu N, Ozcinar B, et al (2014). Factors predicting microinvasion in ductal carcinoma in situ. Asian Pac J Cancer Prev. 15, 55-60.
  42. Pyszel A, Malyszczak K, Pyszel K, et al (2006). Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema. Lymphology, 39, 185-92.
  43. Powell SN, Taghian AG, Kachnic LA, et al (2003). Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys, 55, 1209-15.
  44. Paskett ED, Naughton MJ, McCoy TP, et al (2007). The epidemiology of arm and hand swelling in premenopausal breast cancer survivors. Cancer Epidemiol Biomarkers Prev, 16, 775-82.
  45. Park JH, Lee WH, Chung HS (2006). Incidence and risk factors of breast cancer lymphoedema. J Clin Nurs, 2008, 17, 1450-9.
  46. Ridner SH. Pretreatment lymphedema education and identified educational resources in breast cancer patients. Patient Educ Couns, 61, 72-9.
  47. Ridner SH, Dietrich MS, Stewart BR, et al (2011). Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer, 19, 853-7.
  48. Sakorafas GH, Peros G, Cataliotti L, et al (2010). Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol, 15, 153-65.
  49. Sagen A, Karesen R, Risberg MA (2009). Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Acta Oncol, 48, 1102-10.
  50. Shih YC, Xu Y, Cormier JN, et al (2009). Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol, 27, 2007-14.
  51. Schrenk P, Rieger R, Shamiyeh A, et al (2000). Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer, 88, 608-14.<608::AID-CNCR17>3.0.CO;2-K
  52. Soran A, D'Angelo G, Begovic M, et al (2006). Breast cancerrelated lymphedema--what are the significant predictors and how they affect the severity of lymphedema?. Breast J, 12, 536-43.
  53. Tsai RJ, Dennis LK, Lynch CF, et al (2009). The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol, 16, 1959-72.

Cited by

  1. The Spectrum of Genetic Mutations in Breast Cancer vol.16, pp.6, 2015,
  2. Therapy modalities to reduce lymphoedema in female breast cancer patients: a systematic review and meta-analysis vol.159, pp.1, 2016,
  3. Prevalência de linfedema após tratamento de câncer de mama em pacientes com sobrepeso vol.23, pp.3, 2016,
  4. Association between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema vol.28, pp.3, 2017,
  5. Lymphatic Function in the Early Postoperative Period of Breast Cancer Has No Short-Term Clinical Impact vol.14, pp.4, 2016,
  6. Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction vol.268, pp.6, 2018,
  7. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng Lymphedema Grading for Unilateral Extremity Lymphedema vol.268, pp.3, 2018,
  8. The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study vol.25, pp.3, 2018,