Arm lymphoedema in a cohort of breast cancer survivors 10 years after diagnosis

Abstract

Introduction: Arm lymphoedema is a frequent complication after breast cancer treatment. Early diagnosis and treatment is considered important for successful management of breast cancer related arm lymphoedema (BCRL). The purpose was to identify BCRL incidence, time of onset, progression/regression and associated factors 10 years after breast cancer diagnosis.

Material and methods: Two hundred and ninety two patients treated with axillary node dissection and radiotherapy were included in this retrospective study. A total of 111 diagnosed with BCRL (incidence 38.7%). Of these women 98 were followed for up to 10 years after BCRL diagnosis. Forty consecutive patients registered with no BCRL were included in the control group. BCRL was defined as an increase in arm volume difference >or=5% and an increased thickness of subcutis. Follow-up was performed twice a year, including assessment of lymphoedema relative volume (LRV) by water displacement method and compression treatment. Additional intensive treatment was given if LRV increased by more than 5% since the previous visit or exceeded 20% in total.

Results: Mean LRV was 8.1 +/-3.6% at diagnosis and 9.0+/-6.7% at last follow-up measurement (mean 48.9+/-39.2 months) with no significant difference. There was no difference in progression of LRV between groups with early versus late diagnosis (within or after 12 months postoperatively), small (5-<10%) versus large (>or=10%) LRV at time of diagnosis, or regular (at least twice a year) versus non-regular treatment. More BCRL patients with large LRV at diagnosis (15.8%), exceeded LRV >or=20% during follow-up time, than patients with small LRV at diagnosis (10.1%).

Conclusion: BCRL can be identified at an early stage both in regard to time of diagnosis after operation and to edema volume, and that edema volume can be kept at a low level for at least 10 years. Small LRV at time of diagnosis appears to be more important for minimizing the progression of LRV than time of diagnosis after operation.