Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors

Treatment-related factors may increase the risk for arm lymphedema, which may occur after surgery or even many years after initial treatment for breast cancer. The association between treatment-related risk factors and development of arm lymphedema was examined for women who participated in the long-term quality of life (LTQOL) study, a 12-15-year follow-up of a breast cancer case-control study of Hispanic and non-Hispanic white women. Among 199 cases, 43 women (15 Hispanic, 28 non-Hispanic white) reported physician-diagnosed lymphedema during follow-up. Multivariable logistic regression analysis was used to calculate the odds ratios (OR) and 95 % confidence intervals (CI) for the association of risk factors with lymphedema, adjusting for relevant covariates. Tamoxifen had a non-significant, positive association with lymphedema (OR = 2.07, 95 % CI 0.94-4.55, p =0.07). There were no significant associations with type of surgery, radiation, or chemotherapy. Risk was increased specifically in overweight and obese women (body mass index (BMI) > =25 kg/m(2)) treated with tamoxifen (OR = 2.62, 95 % CI 0.99-6.93, p = 0.05). This study suggests that breast cancer survivors with a BMI > 25 who report the use of tamoxifen therapy may be at increased risk for arm lymphedema. Larger case-control studies and clinical trials should investigate the long-term association of tamoxifen treatment with arm lymphedema especially in overweight and obese women. Lymphedema risk may be another indication to consider a weight reduction program in breast cancer survivors.