Breast cancer related lymphoedema (BCRL): Prevalence and evaluation of risk factors

Abstract

Among cancer related mortality and morbidity, the Breast cancer is commonest causein women worldwide . Despite of improved treatment technique of the breast cancer,the incidence some refractory complications like breast cancer related lymphoedema(BCRL) of corresponding arm has increased ,which is related to treatment modalitieslike axillary staging, axillary irradiation or both . BCRL is an agonizing complicationwhich limits day to day activity of the patient and becomes more relevant as thesurvival after diagnosis of breast cancer increases. Due to lack of standard definitionand standardized criteria for evaluation, the incidence varies. This Cohort study withhistorical cohort and prospective follow-up for 1 year aimed to determine the prevalence, risk factors, influence of axillary staging and locoregional radiotherapy in thedevelopment of BCRL .Methods: From May 2017 to March 2019 , clinical records of 180 Breast cancer patientswere reviewed from 3 different institutes with Stage I to stage III breast cancertreated with BCT(breast conservation surgery ), MRM (Modified Radical Mastectomy) and RT( Radiotherapy) in addition to systemic chemotherapy and the patients werefollowed up till 1 year. Data were recorded in terms of age, menopausal status, bodymass index (BMI) and presence of co-morbid conditions. Difference between bothupper limb circumferences at any level of more than 2 cm was considered as significantlymphoedema. With the help of SPSS software, all the statistical calculationwas done. Results: The prevalence of clinically significant lymphedema was 32.7%.The prevalence of lymphedema was 34% % in patients treated with MRM where asit was 20% in patients treated with Breast conservative surgery. Among sub groupof MRM in which more than 4 LN came to be positive were having significant lymphedema(42%) as compared to less than 4 LN positive patients(21%). It was observedthat BMI(Body mass index), presence of co-morbid conditions and chemotherapywere not significantly associated with BCRL. Post-operative radiotherapy (axillaryirradiation) appears to be an independent risk factor for development of BCRL inmultivariate analysis (P 25kg/m2 patients . Women whounderwent MRM with more than 4 positive lymph nodes had significantly more numberlymphedema patients . Radiotherapy was found to be independent risk factor forthe development lymphedema, suggesting that the combination of axillary staging andradiation therapy puts patient at much higher risk of lymphedema development.Key words: Breast cancer–lymphoedema