Obesity increases lymphedema risk for breast cancer survivors

December 18, 2008

COLUMBIA, Mo. - Throughout the world, 10 million breast cancer survivors have a lifetime risk for developing lymphedema, a chronic condition that involves swelling of the limbs and impacts physical and psychosocial health. Second only to the recurrence of cancer, it is the most dreaded effect of breast cancer treatment. In a new study, University of Missouri researchers found that the risk of developing lymphedema is 40 percent to 60 percent higher in women with body mass index (BMI) classified as overweight or obese compared to normal weight women. The researchers recommend increased health education for breast cancer survivors.

"Breast cancer survivors with high BMIs will benefit from education focused on maintaining optimal BMI and lymphedema risk reduction practices," said Jane Armer, professor in the Sinclair School of Nursing and director of nursing research at the Ellis Fischel Cancer Center. "Overweight women have the greatest risk of developing lymphedema and should be monitored closely for changes in symptoms and limb volume, especially those who have cancer treatment to the dominant side or experience post-operation swelling."

Based on the analysis, lymphedema is a risk for approximately two-thirds of breast cancer survivors in the 30 months after surgery. Breast cancer survivors who develop post-op swelling have a significantly higher risk (40 percent) of developing lymphedema. According to Armer, patients with high BMIs who experience post-op swelling or were affected by cancer on their dominant side have the highest risk of developing lymphedema. MU researchers found that comparing BMI and limb volume measurements can help clinicians better detect lymphedema.

"Diagnosing post-breast cancer lymphedema can be difficult because of inconsistent measurement approaches and standards of measurement reliability and validity," Armer said. "Pre-op limb volume measurement is an essential reference for post-op volume comparison and detection of post-op swelling. Clinicians should consider using a 5 percent limb volume change (LVC) approach (beyond change in BMI) as a more sensitive estimation of post-breast cancer lymphedema."
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The study, "Post-Op Swelling and Lymphoedema Following Breast Cancer Treatment," was published in the Journal of Lymphoedema, Vol. 3, No. 2. It was co-authored by Wannapa Kay Mahamaneerat, contract research scientist for the Post-Breast Cancer Lymphedema Project at MU and former graduate research assistant in the MU Sinclair School of Nursing and Computer Science Department; Chi-Ren Shyu, director of the MU Informatics Institute; and Bob Stewart, adjunct clinical faculty in the nursing school and professor emeritus of agricultural education at MU.

University of Missouri-Columbia

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