Black and Hispanic Women May Have Higher Risk of Lymphedema
Among women who had breast cancer surgery and axillary lymph node dissection, Black and Hispanic women were more likely to develop lymphedema than white women, as were women who received chemotherapy before surgery, rather than after surgery, according to a small study.
The research was published online on June 9, 2022, by the journal JAMA Oncology. Read the abstract of “Risk Factors and Racial and Ethnic Disparities in Patients With Breast Cancer-Related Lymphedema.”
Lymphedema is abnormal swelling that can develop in the arm, hand, breast, or torso as a side effect of breast cancer surgery, radiation therapy, or both. The condition can develop months or even years after treatment ends.
Breast cancer surgery and radiation therapy can cut off or damage some of the remaining lymph nodes and lymph channels in the affected area, which can keep lymph fluid from flowing through the body easily. Over time, lymph fluid can overwhelm these remaining channels and build up in the body’s tissues near the treated area.
Experts estimate that about 20% to 30% of women diagnosed with breast cancer develop lymphedema.
Risk factors for lymphedema include:
axillary lymph node dissection
having multiple surgeries in the chest area
being overweight or obese
Still, axillary lymph node dissection is the main risk factor for lymphedema.
About axillary lymph node dissection
Surgeons usually perform axillary lymph node dissection at the same time as mastectomy or lumpectomy as part of early-stage breast cancer treatment. A surgeon removes five or more lymph nodes in the armpit area on the same side as the breast cancer. A pathologist then examines the lymph nodes to see if there are any cancer cells in them.
If cancer cells are present in the removed lymph nodes, there is a higher risk of the breast cancer coming back — called recurrence by doctors.
When a pathology report shows cancer cells in the lymph nodes, doctors recommend more treatment after surgery, such as radiation therapy, chemotherapy, and possibly targeted therapy.
About the study
Earlier studies have suggested that Black women have a higher risk of lymphedema than white women. Still, it’s unclear why. It also hasn’t been clear if receiving chemotherapy before surgery — called neoadjuvant chemotherapy by doctors — rather than after surgery affects lymphedema risk.
In this study, the researchers wanted to gather more information about lymphedema risk factors.
The study included 266 women who had breast cancer surgery and axillary lymph node dissection between November 2016 and March 2020 at Memorial Sloan Kettering Cancer Center. Of all the women in the study:
166 women were white
55 women were Black
29 women were Asian
16 women were Hispanic
half the women were younger than 48 and half were older
68% of the women were diagnosed with hormone receptor-positive, HER2-negative breast cancer
70% of the women received chemotherapy before surgery
half the women had fewer than 18 lymph nodes removed and half had more than 18 lymph nodes removed
24% of the women had lumpectomy and 76% had mastectomy
85% of the women had breast reconstruction with an implant, 15% had reconstruction using tissue from another place on their bodies (called autologous or flap reconstruction by doctors), and 27% had no reconstruction
The researchers followed half the women for less than 22.6 months and half for a longer period of time.
The researchers also measured the women’s arm volume using a perometer:
before breast cancer surgery
every six months after surgery
A perometer uses infrared light to scan a limb and is considered to offer a highly accurate measurement of limb size and volume.
Among all the women, after 24 months of follow-up, 23.8% developed lymphedema.
The researchers looked at the number of women in each racial or ethnic group to see how many developed lymphedema:
37.2% of Black women developed lymphedema
27.7% of Hispanic women developed lymphedema
22.5% of Asian women developed lymphedema
19.8% of white women developed lymphedema
The differences in lymphedema rates were statistically significant, which means they were likely due to the differences in race and ethnicity and not just because of chance.
Lymphedema rates also were higher among women who received chemotherapy before surgery:
29.3% of women who received chemotherapy before surgery developed lymphedema
11.1% of women who had surgery first developed lymphedema
The researchers found that the following factors were linked to developing lymphedema:
being a Black woman
being a Hispanic woman
receiving chemotherapy before surgery
having more time pass after breast cancer surgery
The researchers pointed out that because the number of Hispanic women in the study was so small, more research is needed to confirm the result for that group of women.
What this means for you
Black and Hispanic woman who’ve been diagnosed with early-stage breast cancer may find the results of this study troubling.
The results suggest that Black and Hispanic women have a higher risk of lymphedema than white women, but the reason is not clear.
You can’t control the characteristics of the cancer you’ve been diagnosed with, and you also can’t control the cancer treatments your doctor recommends to keep your risk of recurrence as low as it can be. But there are steps you can take to reduce your risk of lymphedema and increase the chances of noticing its early symptoms.
Before breast cancer surgery, it’s a good idea to meet with a lymphedema specialist, physical therapist, or other medical professional who specializes in breast cancer-related lymphedema management to record baseline measurements of your arm and hand, as well as to assess your arm and upper body strength.
Having baseline measurements can help you better judge any changes in the size of your arm and hand over time.
Knowing your pre-surgery upper body strength can help your specialist develop a post-surgery exercise and rehabilitation program tailored to your unique needs.
A specialist also can tell you about the signs and symptoms of lymphedema and what to do if you experience them.
Learn more about Reducing Risk of Lymphedema and Lymphedema Flare-Ups.
Written by: Jamie DePolo, senior editor
— Last updated on June 28, 2022, 8:02 PM