Development of breast cancer-related lymphedema: is it dependent on the patient, the tumor or the treating physicians?

INTRODUCTION: Breast cancer-related lymphedema (LE) is relatively common. The aim of this study was to identify the risk factors involved in the development of this complication. METHODOLOGY: This was a cross-sectional study of breast cancer patients treated at our Center between 2004 and 2009. A total of 515 patients were included. Lymphedema was defined as a mid-arm or forearm circumference difference between both limbs of 2 cm or more. RESULTS: The incidence of LE in this population was 21.4 %. Patients with a BMI of 25 or higher had a significantly higher risk of LE (p = 0.002). The presence of lymphovascular invasion (LVI) (p = 0.05) and the number of positive lymph nodes (LN) (p = 0.001) were both associated with LE. Patients who underwent axillary dissection (AD) had a significantly higher incidence of LE than patients who had a sentinel LN biopsy (25 vs. 4.5 %). Adjuvant radiotherapy was also a significant risk factor in patients who had a mastectomy (p = 0.003). CONCLUSION: There are multiple risk factors for LE. Most of those factors can be influenced by early tumor detection. Early tumors are smaller with no LVI or axillary LN metastasis. They do not usually require AD or axillary radiotherapy, which are the strongest factors associated with the development of LE.

Histo-biological comparative analysis of bilateral breast cancer.

Bilateral breast cancer occurs in approximately 7% of surviving breast cancer patients. However, a dilemma exists concerning the notion of whether this represents a de novo second primary tumor versus a breast metastasis. We analyzed 81 patients with bilateral breast cancer, 47 (58%) synchronous tumors and 34 (42%) metachronous tumors. Additionally, charts were reviewed for age, family history, full histology data and biological receptors. We found there were no significant differences in concordance between the first and second primary tumors (in both synchronous and metachronous bilateral breast cancer) with respect to histology; grade; T-category; N-category; ER, PR and HER-2 status. In addition, there was no significant difference in the strength of correlation between ER and PR in the first and secondary primary tumors. Our findings suggest that the differentiation of the origin of contralateral breast cancer based on routine histological and biological concordance is inconclusive. Furthermore, the dilemma will continue to exist until additional molecular approaches are applied routinely for research purposes to resolve the debate.

Lymphedema. A significant health problem for women with breast cancer in Jordan.

OBJECTIVE: To investigate the frequency of breast cancer related lymphedema in our region, and to heighten its awareness among health workers. METHODS: This is a cross-sectional study of patients treated with breast cancer at King Hussein Cancer Center, Amman, Jordan, between January 2004 and December 2009. We excluded patients with bilateral breast cancer. A total of 515 patients were included. We asked the patients to complete questionnaires that included questions related to arm symptoms. Lymphedema was defined as 2 cm or more difference between the 2 upper limbs' girths. RESULTS: The incidence of lymphedema was 21.1%. The subjective evaluation by the patients overestimated the figure (35%). Most patients (75.3%) had limb symptoms, such as pain, numbness, and limitation of movement. In most patients with lymphedema, the symptoms were mild, but in 17 patients (15.6%) the effects were severe. CONCLUSION: Lymphedema continues to be a common health problem in our region. Most patients have mild lymphedema, but in some patients the effects on daily activities are severe. It is important for health workers to understand the significance of this problem and its associated morbidity.