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

• Published in: Diagnostics (Basel) Vol. 11; no. 8; p. 1303
• Main Authors: Yusof, Khairunnisa’ Md, Avery-Kiejda, Kelly A., Ahmad Suhaimi, Shafinah, Ahmad Zamri, Najwa, Rusli, Muhammad Ehsan Fitri, Mahmud, Rozi, Saini, Suraini Mohd, Abdul Wahhab Ibraheem, Shahad, Abdullah, Maha, Rosli, Rozita
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 21-07-2021; MDPI
• Subjects: arm swelling; BCRL; Biopsy; Blood pressure; Body mass index; Breast cancer; Cancer therapies; Chemotherapy; Females; Hypertension; Informed consent; Lymphatic system; Lymphedema; Mastectomy; quality of life; Questionnaires; Radiation therapy; Risk factors; self-reported; Skin; Surgery; Ultrasonic imaging; Malaysia
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics11081303

Breast cancer has been reported to have the highest survival rate among various cancers. However, breast cancer survivors face several challenges following breast cancer treatment including breast cancer-related lymphedema (BCRL), sexual dysfunction, and psychological distress. This study aimed to investigate the potential risk factors of BCRL in long term breast cancer survivors. A total of 160 female breast cancer subjects were recruited on a voluntary basis and arm lymphedema was assessed through self-reporting of diagnosis, arm circumference measurement, and ultrasound examination. A total of 33/160 or 20.5% of the women developed BCRL with significantly higher scores for upper extremity disability (37.14 ± 18.90 vs. 20.08 ± 15.29, p < 0.001) and a lower score for quality of life (103.91 ± 21.80 vs. 115.49 ± 16.80, p = 0.009) as compared to non-lymphedema cases. Univariate analysis revealed that multiple surgeries (OR = 5.70, 95% CI: 1.21–26.8, p < 0.001), axillary lymph nodes excision (>10) (OR = 2.83, 95% CI: 0.94–8.11, p = 0.047), being overweight (≥25 kg/m2) (OR = 2.57, 95% CI: 1.04 – 6.38, p = 0.036), received fewer post-surgery rehabilitation treatment (OR = 2.37, 95% CI: 1.05–5.39, p = 0.036) and hypertension (OR = 2.38, 95% CI: 1.01–5.62, p = 0.043) were associated with an increased risk of BCRL. Meanwhile, multivariate analysis showed that multiple surgeries remained significant and elevated the likelihood of BCRL (OR = 5.83, 95% CI: 1.14–29.78, p = 0.034). Arm swelling was more prominent in the forearm area demonstrated by the highest difference of arm circumference measurement when compared to the upper arm (2.07 ± 2.48 vs. 1.34 ± 1.91 cm, p < 0.001). The total of skinfold thickness of the affected forearm was also significantly higher than the unaffected arms (p < 0.05) as evidenced by the ultrasound examination. The continuous search for risk factors in specific populations may facilitate the development of a standardized method to reduce the occurrence of BCRL and provide better management for breast cancer patients.