LYMPHEDEMA SECONDARY TO BREAST CANCER: HOW CHOICE OF MEASURE INFLUENCES DIAGNOSIS, PREVALENCE, AND IDENTIFIABLE RISK FACTORS

Abstract

Research on secondary lymphedemaprimarily uses indirect methods for diagnosis.This paper compares prevalence and cumulativeburden following breast cancer surgery,as well as personal, treatment, and behavioralcharacteristics associated with lymphedema,using different assessment techniques.Lymphedema status was assessed at threemonthlyintervals between six- and 18-monthspost-surgery in a population-based sample ofAustralian women with recently diagnosed,unilateral, invasive breast cancer, using threemethods: bioimpedance spectroscopy (BIS),difference between sum of arm circumferences(SOAC) and self-report. Depending on themethod, point prevalence ranged between 8 to28%, with 1 in 5 to 2 in 5 women experiencinglymphedema at some point in time. Of thosewith lymphedema defined by BIS, almost40%-60% went undetected, and 40%-12%were misclassified as having lymphedema,based on self-report and SOAC, respectively.The choice of measure also had significantimplications for identified risk factors. Over10 characteristics were associated withlymphedema, however only one, experiencingother upper-body symptoms at baseline,influenced odds of lymphedema across allthree methods. These findings highlight thatsecondary lymphedema poses a significantpublic health problem. Utilizing the most accurate and reliable method for assessmentis crucial to advance our understanding ofpreventive and treatment strategies.