A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Breast Cancer Women
Identifieur interne : 003202 ( Ncbi/Curation ); précédent : 003201; suivant : 003203A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Breast Cancer Women
Auteurs : Tina W. F. Yen ; Xiaolin Fan ; Rodney Sparapani ; Purushuttom W. Laud ; Alonzo P. Walker ; Ann B. NattingerSource :
- Annals of surgical oncology [ 1068-9265 ] ; 2009.
Descripteurs français
- KwdFr :
- Biopsie de noeud lymphatique sentinelle (effets indésirables), Enquêtes de santé, Enregistrements, Facteurs de l'âge, Facteurs de risque, Femelle, Humains, Lymphadénectomie (effets indésirables), Lymphoedème (étiologie), Medicare (USA), Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (anatomopathologie), États-Unis d'Amérique.
- MESH :
- anatomopathologie : Tumeurs du sein.
- effets indésirables : Biopsie de noeud lymphatique sentinelle, Lymphadénectomie.
- étiologie : Lymphoedème.
- Enquêtes de santé, Enregistrements, Facteurs de l'âge, Facteurs de risque, Femelle, Humains, Medicare (USA), Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein, États-Unis d'Amérique.
- Wicri :
- geographic : États-Unis.
English descriptors
- KwdEn :
- MESH :
- geographic : United States.
- adverse effects : Lymph Node Excision, Sentinel Lymph Node Biopsy.
- etiology : Lymphedema.
- pathology : Breast Neoplasms.
- surgery : Breast Neoplasms.
- Age Factors, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Medicare, Registries, Risk Factors.
Abstract
We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.
Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries.
Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were the removal of more than five lymph nodes (OR 4.68-5.61, 95% CI: 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for > 15 nodes) and the presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24).
Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors have self-reported lymphedema. In this group of predominately community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.
Url:
DOI: 10.1245/s10434-009-0347-2
PubMed: 19194754
PubMed Central: 2729500
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PMC:2729500Le document en format XML
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<author><name sortKey="Sparapani, Rodney" sort="Sparapani, Rodney" uniqKey="Sparapani R" first="Rodney" last="Sparapani">Rodney Sparapani</name>
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<author><name sortKey="Laud, Purushuttom W" sort="Laud, Purushuttom W" uniqKey="Laud P" first="Purushuttom W." last="Laud">Purushuttom W. Laud</name>
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<author><name sortKey="Walker, Alonzo P" sort="Walker, Alonzo P" uniqKey="Walker A" first="Alonzo P." last="Walker">Alonzo P. Walker</name>
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<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Breast Neoplasms (pathology)</term>
<term>Breast Neoplasms (surgery)</term>
<term>Female</term>
<term>Health Surveys</term>
<term>Humans</term>
<term>Lymph Node Excision (adverse effects)</term>
<term>Lymphedema (etiology)</term>
<term>Medicare</term>
<term>Registries</term>
<term>Risk Factors</term>
<term>Sentinel Lymph Node Biopsy (adverse effects)</term>
<term>United States</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle (effets indésirables)</term>
<term>Enquêtes de santé</term>
<term>Enregistrements</term>
<term>Facteurs de l'âge</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Lymphadénectomie (effets indésirables)</term>
<term>Lymphoedème (étiologie)</term>
<term>Medicare (USA)</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tumeurs du sein ()</term>
<term>Tumeurs du sein (anatomopathologie)</term>
<term>États-Unis d'Amérique</term>
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<keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term>
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<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term>
<term>Sentinel Lymph Node Biopsy</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Tumeurs du sein</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle</term>
<term>Lymphadénectomie</term>
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<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term>
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<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term>
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<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term>
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<keywords scheme="MESH" xml:lang="en"><term>Age Factors</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Female</term>
<term>Health Surveys</term>
<term>Humans</term>
<term>Medicare</term>
<term>Registries</term>
<term>Risk Factors</term>
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<term>Enregistrements</term>
<term>Facteurs de l'âge</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Medicare (USA)</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tumeurs du sein</term>
<term>États-Unis d'Amérique</term>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>BACKGROUND:</title>
<p id="P1">We studied potential risk factors for lymphedema in a contemporary population of older breast cancer patients.</p>
</sec>
<sec id="S2"><title>METHODS:</title>
<p id="P2">Telephone surveys were conducted among women (65-89 years) identified from Medicare claims as having initial breast cancer surgery in 2003. Lymphedema was classified by self-report. Surgery and pathology information was obtained from Medicare claims and the state cancer registries.</p>
</sec>
<sec id="S3"><title>RESULTS:</title>
<p id="P3">Of 1,338 patients treated by 707 surgeons, 24% underwent sentinel lymph node biopsy (SLNB) and 57% axillary lymph node dissection (ALND). At a median of 48 months postoperatively, 193 (14.4%) had lymphedema. Lymphedema developed in 7% of the 319 patients who underwent SLNB and 21% of the 759 patients who underwent ALND. When controlling for patient age, tumor size, type of breast cancer, type of breast and axillary surgery, receipt of radiation, chemotherapy, and hormonal therapy, and surgeon case volume, the independent predictors of lymphedema were the removal of more than five lymph nodes (OR 4.68-5.61, 95% CI: 1.36-19.74 for 6-15 nodes; OR 10.50, 95% CI 2.88-38.32 for > 15 nodes) and the presence of lymph node metastases (OR 1.98, 95% CI 1.21-3.24).</p>
</sec>
<sec id="S4"><title>CONCLUSIONS:</title>
<p id="P4">Four years postoperatively, 14% of a contemporary, population-based cohort of elderly breast cancer survivors have self-reported lymphedema. In this group of predominately community-based surgeons, the number of lymph nodes removed is more predictive of lymphedema rather than whether SLNB or ALND was performed. As more women with breast cancer undergo only SLNB, it is essential that they still be counseled on their risk for lymphedema.</p>
</sec>
</div>
</front>
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