Development of breast cancer-related lymphedema is not equally distributed between races. Black women experienced higher rates of breast cancer-related lymphedema than White women, results of a prospective study show. Mechanisms behind racial disparities in the development of lymphedema require further investigation.
Lymphedema is a well-known and quality-of-life-lowering side effect of breast cancer treatment, particularly for women who undergo axillary lymph node dissection. Epidemiological and self-reported data suggests that Black women may be at increased risk of developing breast cancer-related lymphedema after axillary lymph node dissection, though prospective clinical data is lacking. Dr. Andrea Barrio (Memorial Sloan Kettering Cancer Center, NY, USA) presented results from a prospective study that investigated the impact of race and ethnicity on breast cancer-related lymphedema incidence and severity [1]. The study enrolled 304 patients who underwent axillary lymph node dissection and 276 patients who had at least one longitudinal measurement after baseline were included in the analysis. Sixty percent of the participants were White; 20% were Black; 11% were Asian; 6% were Hispanic (3% did not report race or ethnicity). Black women were older (P=0.007), had higher baseline BMI (P<0.001), and were more likely to be clinically node-positive (P=0.016) compared with White, Asian, and Hispanic women. Both Black and Hispanic women were more likely to undergo breast-conserving surgery (P=0.037) and receive nodal radiotherapy (P=0.02). Arm volume was measured at baseline, post-operatively, and at 6-month intervals. Breast cancer-related lymphedema was defined as a relative volume change of ≥10% from baseline. At a median follow-up of 1.6 years, 50 women developed breast cancer-related lymphedema. The 24-month breast cancer-related lymphedema rate was 20.5% for White women, 23.4% for Asian women, 27.7% for Hispanic women, and 39.4% for Black women. On multivariant analysis, Black race was the strongest predictor of breast cancer-related lymphedema development (OR 3.53; P<0.001), compared with White race. Hispanic ethnicity was also associated with a higher incidence of breast cancer-related lymphedema (OR 3.11), however, the number of Hispanic patients was low. In addition, neoadjuvant chemotherapy was associated with a 2-fold increase (OR 2.07; P=0.017) of breast cancer-related lymphedema incidence. Among patients with lymphedema, there was no difference in lymphedema severity across racial and ethnic groups, with similar relative volume changes observed. “The etiology for the higher observed incidence of lymphedema in Black women is unknown,” said Dr. Barrio. “It may be due to race-based differences in inflammatory reaction, tissue fibrosis, and lymphatic function. Future studies should address the biologic mechanisms behind racial disparities in lymphedema development and investigate possible preventive strategies.”
- Montagna G, et al. Impact of race and ethnicity on incidence and severity of breast cancer related lymphedema after axillary lymph node dissection: Results of a prospective screening study. SABCS 2021 Virtual Meeting, abstract GS4-01.
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