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Sarah M. Beaulac, MPH; Lindsay A. McNair, MD,MPH; Thayer E. Scott, MPH; Wayne W. LaMorte, MD,PhD,MPH; Maureen T. Kavanah, MD

Arch Surg. 2002;137:1253-1257.

Background  The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery.

Hypothesis  Women who experience breast cancer–related lymphedema have a measurable reduction in quality of life compared with women without lymphedema.

Design  In a retrospective cohort study, we explored the association between lymphedema and quality of life, controlling for patient demographics, surgical factors, and treatment types.

Settings  An urban academic medical center and a community hospital.

Participants  A total of 151 women surgically treated for early-stage breast cancer (stages 0-II) were assessed at least 1 year after their ALND. The women had been treated with either conservative surgery and radiation or mastectomy without radiation.

Main Outcome Measures  Arm volume was measured by water displacement. Grip strength and range-of-motion measurements assessed arm function. The Functional Assessment of Cancer Therapy–Breast (FACT-B) quality-of-life instrument assessed breast, emotional, functional, physical, and social well-being.

Results  Lymphedema (an arm volume difference 200 cm³) was measured in 42 women (27.8%). Mastectomy or conservative surgery patients had similar lymphedema rates. Women with lymphedema in both surgical groups scored significantly lower on 4 of the 5 subsections than women without lymphedema, even after adjusting for other factors influencing quality of life.

Conclusions  Lymphedema occurs at appreciable rates, and its impact on long-term quality of life in survivors of early-stage breast cancer should not be underestimated.

From the Departments of Epidemiology and Biostatistics (Ms Beaulac and Drs McNair and LaMorte) and Surgery (Ms Scott and Drs LaMorte and Kavanah), Boston University Medical Center, Boston, Mass.

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