Number of Nodes Removed Signals Lymphedema Risk
Among older survivors of breast cancer, lymphedema may be most likely to develop when more than 5 lymph nodes have been removed during surgery and when cancer is present in the lymph nodes. According to the surgical oncologist whose investigative team uncovered these findings, this swelling of the arm and hand “is probably the most feared complication among breast cancer survivors,” and a better understanding of its risk factors is necessary to help improve patient outcomes.
“Lymphedema causes physical discomfort and disability as well as cosmetic deformity, which can lead to anxiety, depression, and emotional distress that can affect a woman’s activities of daily living and quality of life,” asserted Tina Yen, MD, MS, of the Medical College of Wisconsin and Froedtert Hospital in Milwaukee, in an announcement of the results. The report appeared in Annals of Surgical Oncology (2009;16:979-988).
Dr Yen and her investigative team used Medicare claims to identify a total of 1338 community-dwelling women, ages 65 to 89, who had undergone initial breast cancer surgery in 2003. The researchers surveyed the women via telephone a total of 3 times between 2005 and 2007.
Four years after surgery, 14% of the study subjects reported having lymphedema. Women who developed the problem were more likely to:
• have more extensive disease
• have undergone more extensive surgery
• have received chemotherapy.
But after Dr Yen and her team controlled for patient age, tumor size, type of surgery, other therapies, and surgeon volume, only 2 remaining factors predicted lymphedema risk: the removal of more than 5 lymph nodes and the presence of cancer in lymph nodes.
The risk of lymphedema when no lymph nodes were removed was 4.7%. This did not increase if 1 to 5 lymph nodes were removed. But the removal of 6 to 15 lymph nodes raised lymphedema risk 5-fold, and removal of more than 16 lymph nodes raised the risk by more than 10 times.
Number of nodes removed proved to be even more predictive of lymphedema risk than type of axillary surgery performed (sentinel lymph node biopsy vs axillary node dissection). Based on these findings, the investigators recommend that women undergoing any axillary surgery should still be counseled regarding their risk for lymphedema, although the risk may be minimal for women who have had fewer than 5 lymph nodes removed.
- Michelle
|
