Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis

BACKGROUND. To the authors ’ knowledge, there are no long-term cohort studies of lymphedema, despite the substantial morbidity of arm swelling. The goal of this study was to identify prevalence of breast carcinoma–related lymphedema, time of onset, and associated predictive factors. METHODS. A cohort of 923 women consecutively treated with mastectomy and complete axillary dissection at our center between 1976 and 1978 was observed intensively for 20 years. Two hundred sixty-three study subjects (28.5%) who were alive and recurrence free constituted the cohort for the current study. A subset of 52 women (20 % of study population) with contralateral mastectomy was analyzed separately. Subjects reported circumferential arm measurements taken using a validated instru-ment. In addition to providing analysis of clinical and treatment variables, this study is the first to the authors ’ knowledge to analyze possible etiologic factors in the posttreatment years, such as occupation, general physical activity, and sports/leisure activities. Univariate and multivariate analytic methods were used. RESULTS. At 20 years after treatment, 49 % (128 of 263) reported the sensation o