A recent study, published in the American Journal of Surgery, attempts to shed some light on the different causes and indications for certain patients to develop lymphedema.
Two hundred forty patients who had a mastectomy with full axillary dissection were included in the study. (Please note that this disallows the entire lumpectomy population as well as any woman who has had sentinel node biopsy alone). These women were examined 18 months after surgery. (Again, this eliminates anyone who develops lymphedema after that time frame, and many do)
A "plus" for this study was that they did analyze the effects of several factors which might affect or hasten a diagnosis of lymphedema: age, diabetes, smoking, hypertension, chemotherapy, radiation, tamoxifen usage, cancer staging, body mass index, number of nodes removed/involved, total volume of wound drainage.
In this study, lymphedema presented in 68 women or 28% of the study population. From the limited size of the study and the specific criteria, it appears that axillary radiation and body mass index were the two factors which increased the incidence of lymphedema the most.
A difference of 2 centimeters was considered lymphedema. Patients ranged in age from 28 to 80, with 51 being the mean age. More than half the study group had axillary metastases and 89 had radiation.
While I am happy that there are ongoing studies related to lymphedema (not enough, in my opinion), it is always frustrating to read the conclusions - yes, there is lymphedema in a small percentage of patients according to the studies, but each stuy varies in the conclusions as to what primarily causes secondary lymphedema. Most studies agree that radiation increases the possibility of developing lymphedema. Some studies show BMI (body mass index) as a contributing factor; others believe the number of nodes removed has an effect; still others think that extent of surgery can play a role.
The strange thing about lymphedema is that it can develop immediately after surgery or as long as 20 years post-surgery. Some women can pinpoint an event that triggered this complication (I took a 5 hour plane ride; I was raking leaves for 2 hours; I played a 3 hour tennis match), while others have no clue what set off their lymphedema.
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