Body Mass Index as a Major Risk Factor for Severe Breast Cancer-Related Lymphedema

Abstract

Background: A few studies have examined the characteristics of severe breast cancer-related lymphedema (BCRL). This study aims at analyzing the factors associated with severe lymphedema (LE) across a specific population of patients with BCRL. Methods and Results: Seventy-four patients with BCRL were included and cared for in the Lymphology Unit of Toulouse University Hospital between 2015 and 2016. Characteristics of patients and factors related to severe BCRL were retrospectively assessed. The median age at time of LE was 56 years (30-82). Thirty-five patients (47.3%) had a mastectomy and 72 (97.3%) an axillary lymphadenectomy. Among patients treated with radiation therapy (n = 72), 76.3% received lymphatic nodes irradiation. Fifty-five patients (74.3%) received chemotherapy and 52 (70.3%) a hormonal suppression therapy. A high proportion of patients had severe (>400 mL, 64.9%) and premature LE, with a median time of 13 months since onset of surgery (0.1-400.2). Weight gain between surgery and LE management was more prevalent in obese patients (p = 0.0164). Body mass index (BMI) at BCRL diagnosis was the only risk factor associated with severe LE (p = 0.0132). There was no significant association between LE severity and treatments received for breast cancer. Conclusions: Our study did not show any influence of tumor characteristics and cancer-related treatments on the severity of BCRL. Only BMI at BCRL diagnosis appears as a factor related to severe LE. These results highlight the importance of an education care unit promoting personalized nutritional lifestyle and encouraging physical activity early in the management of breast cancer.

Outcomes of Vascularized Lymph Node Transplantation for Treatment of Lymphedema

“…It is important to interpret these findings in context: as a tertiary referral specialist academic lymphedema center, approximately 70% of the patients in this study had advanced-stage lymphedema (MDACC stage III/IV) and almost half were obese, which causes lymphatic dysfunction and is an independent risk factor for lymphedema development. 5,9 In addition, patients who underwent suction-assisted lipectomy debulking operation at any time were excluded from this study to avoid confounding the results; performing this at an interval period after physiologic operation is effective at removing the soft-tissue volume excess that characterizes chronic lymphedema and that persists after extracellular fluid reduction. 52,53 The limitations of this study are that a single lymphedema-specialist plastic surgeon, supported by specialist plastic surgery colleagues when performing jejunal mesenteric and omental VLN flap harvest, performed all of the procedures, potentially limiting the generalizability of the findings.…”

Lymphaticovenular Anastomosis in Breast Cancer Treatment-Related Lymphedema: A Short-Term Clinicopathological Analysis from Indonesia

“…It was not a surprise to see from our study that lymphedema commonly occurred in patients who were overweight, had ALND (97.1%), and RNI (82.9%) since high BMI, lymph vessel disruption due to surgery, and radiotherapy have become the common risk factors. [27][28][29][30] It is interesting to find out that 80% of the patients were aware of lymphedema symptoms and signs, but it was actually due to 55.7% of patients being in stage 2. Certainly for patients, the higher the stage, the more obvious the symptoms and signs.…”

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

“…In comparison, the average BMI for our non-lymphedema group was classified as overweight (27.3 kg/m 2 ), while the lymphedema group was classified as obese (30.0 kg/m 2 ). Higher BMI and obesity have been well documented as novel and independent risk factors of developing BCRL in many studies [17,21,25,42]. Obesity has been well documented as a novel risk factor associated with BCRL, due to fat hypertrophy in lymphedematous tissue and fibrosis.…”

“…To our knowledge, studies on BCRL in the Asian region are lacking and this study is the first to address BCRL in Malaysian breast cancer survivors. Factors associated with BCRL vary among individuals, depending on the patient factors including age, BMI, stage of breast cancer, types of treatment, or comorbidities [18,25,26]. We aimed to investigate the potential risk factors associated with BCRL in a Malaysian cohort and to evaluate the skin structure of the affected arms.…”