THE DEVELOPMENT OF BREAST CANCER-RELATED LYMPHEDEMA AFTER MASTECTOMY IN A RURAL POPULATION: A SINGLE-INSTITUTION EXPERIENCE

Objectives: Breast cancer-related lymphedema (BCRL) is a lifelong condition that can impact quality of life. Its prevalence is 20-30% and typically develops between 6-36 months after surgery. Previous research shows that BCRL development is associated with age, obesity, axillary lymph node dissection (ALND), chemotherapy, radiation, and wound complications. These studies were performed with national or statewide databases and did not specifically examine risk factors in a rural population. Our aim was to determine the risk factors for the development of BCRL after mastectomy in a rural population.

Methods: Retrospective review of mastectomy patients from 2017-2021 was performed with a prospectively enrolled tumor registry database at a single institution. Patients with incomplete records were excluded. BCRL was diagnosed by surgeon during follow-up. Statistical analysis utilized frequencies and percentages, descriptive statistics, logistic and linear regression models.

Results: 475 patients were included, with an average age of breast cancer diagnosis of 59.3 years, BMI of 29.1, and length of follow-up of 23.9 months. Within this population, 40 (8.4%) patients were diagnosed with BCRL. BCRL was significantly associated with tumor-involved lymph nodes (OR = 10.75, p < 0.001), adjuvant radiation (OR = 9.31, p < 0.001), ALND (OR 6.41, p < 0.001), adjuvant chemotherapy (OR = 4.05, p < 0.001), adjuvant endocrine therapy (OR = 2.64, p= 0.048), and median household income (OR = 1.16, p = 0.05). Reconstruction reduced the risk of BCRL (OR = 0.43, p = 0.016). Factors that approached significance with positive association included tumors >T2 (OR = 1.71, p = 0.11) and neoadjuvant therapy (OR = 1.85, p = 0.09). Factors that approached significance with negative association included allogenic reconstruction (OR = 0.54, p = 0.08), and distance traveled by patients (OR = 0.98, p = 0.10). There was no significant association in our population with age, BMI, diabetes, tobacco use, cancer type, receptor status, overall complications, wound infection or dehiscence, hematoma or reoperation.

Conclusion: While many of these results are consistent with prior findings, historic factors such as age, obesity, tobacco use, wound complications and reoperation were not significantly associated with BCRL in this rural population. This study demonstrates that individuals underrepresented in the literature, such as patients in largely rural communities, have some differences in risk factors for developing BCRL when compared to national studies. These populations deserve special attention on a regional or single institution level in order to counsel patients appropriately and guide management.