Black women 3.5 times more likely than white to develop breast-cancer related lymphedema

Black women are significantly more likely to developing breast-cancer related lymphedema than white women. Those of Hispanic decent may also have an increased risk. This comes from a prospective study of breast cancer patients who underwent axillary lymph node dissection (ALND). Lymphedema is a known complication following axillary surgery for breast cancer, but the degree to which racial or ethnic backgrounds play a role has not been clear. Researchers investigated whether lymphedema rates triggered by ALND differed by race and ethnicity. Findings were presented at the San Antonio Breast Cancer Symposium by Dr. Andrea Barrio, an associate attending physician at Memorial Sloan Kettering Cancer Center. Read: Canada's breast cancer screening policy based off flawed study: researchers “Breast cancer lymphedema is a frequent and serious complication following axillary surgery for breast cancer. Axillary lymph node dissection remains the main risk factor for the development of lymphedema. Other important risk factors such as older age, increasing BMI, systemic chemotherapy such as taxane-containing regimens and radiotherapy are inconsistent across studies,” she said. Women aged 18 years and older with breast cancer who were undergoing unilateral ALND between November 2016 and March 2020, either in the primary setting or after sentinel lymph node biopsy, were enrolled. Both arm volume measurements (done with a perometer which used a sliding frame and an infrared light sensor to measure arm volume) and body mass index (BMI) were evaluated at baseline, post-operatively, and at six-month intervals. An increase of arm volume of 10% or more from baseline was diagnostic of lymphedema. A total of 276 women who had at least one longitudinal measurement after baseline were included in the final analyses. Sixty per cent (166) of the patients were Caucasian, 20% (55) were Black, 11% (29) were Asian, and 6% (16) were Hispanic. At baseline, body mass index (BMI) was higher in Black and Hispanic women (median BMI of 30.3 kg/m2 and 28.1 kg/m2, respectively) compared to Caucasian women, and Asian women (who had a median BMI of 25.2 kg/m2 and 22.2 kg/m2, respectively). Black and Hispanic women were more likely to be clinically node positive compared to white and Asian women. At baseline, body mass index (BMI) was higher in Black and Hispanic women (median BMI of 30.3 kg/m2 and 28.1 kg/m2, respectively) compared to Caucasian women, and Asian women (who had a median BMI of 25.2 kg/m2 and 22.2 kg/m2, respectively) Black women were more likely to have cN1 disease (cancer that has spread to one to three axillary lymph nodes) and Hispanic women more likely to have cN2/3 disease (has spread to 4 or more lymph nodes) compared to Caucasian and Asian women. A total of 70% of the study population received neoadjuvant chemotherapy (NAC), and 26% had adjuvant chemotherapy. A total of 95% of percent of patients received radiotherapy, and 93% underwent nodal radiotherapy. Overall, 94% of patients who received chemotherapy received a taxane-containing regimen. Both Black and Hispanic women were more likely to undergo breast-conserving surgery and all of them (100%) received nodal radiotherapy (RT) compared to 92% of white women and 86% of Asian women. At a median follow-up of 22.6 months, 56 women developed breast cancer related lymphedema, with notable differences by race and ethnicity. The incidence of lymphedema was highest in Black women, with a two-year lymphedema rate of 39.4% compared to 27.7% in Hispanic women, 23.4% in Asian women and 20.5% Caucasian women. Lymphedema incidence also varied by treatment group, with lymphedema incidence being twofold greater among women treated with NAC compared to those who underwent upfront surgery (30.9% and 11.1% respectively), said Dr. Barrio. “NAC significantly increases lymphedema compared to adjuvant therapy in women undergoing ALND and radiotherapy,” she said. Other factors were also independently associated with increased risk of developing lymphedema, including older age, longer follow-up intervals but overall, being Black was the strongest predictor of lymphedema development. Overall, Black women were 3.5 times more likely to have lymphedema compared to Caucasian women, Dr. Barrio said. The Hispanic women were three times more likely than their white counterparts to development lymphedema, but because of the small numbers of Hispanic women in the study, further study needs to be done to confirm this. Future studies should look for explanations as to why Black women are more likely to develope BCRL. Dr. Barrio noted there may be race-based difference in inflammatory reactions, tissue fibrosis and lymphatic function. According to Dr. Virginia Kaklamani, professor of medicine at the University of Texas Health San Antonio, this is an important study “looking at how ethnicity plays a role in potential adverse reactions from our treatment.” She was not involved in the story but spoke at the conference. “We already know that African-American women have a higher rate of triple negative breast cancer which is one of the most aggressive breast cancers to treat. Now we’re seeing in a well conducted trial that African-American women have a higher risk of lymphedema. I think it’s important for us to be able to recognize this, recognize the symptoms early and treat our patients pre-emptively so that we can potentially prevent them from being like these patients,” she said.

Black women 3.5 times more likely than white to develop breast-cancer related lymphedema

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