A Cross-sectional Study Examining the Risk Factors Associated with Lymphedema and its Prevalence in Breast Cancer Patients after Level 3 Axillary Lymph Node Dissection

Objective: To determine the prevalance of lymphedema after breast cancer treatment with level 3 axillary lymph node dissection (ALND) and to evaluate the risk factors which underlie this condition. Material and Methods: A total of 190 women >18-years-old who underwent breast cancer treatment with level 3 ALND >6 months ago were included in this cross-sectional study. The sociodemographic and clinical characteristics of all of the patients were recorded, and all patients were evaluated for lymphedema of the upper extremity by a circumferential measurement method. Results: On examination, 79 (41.5%) women had lymphedema with a mean development time of 12.7 +/- 26.62 months. After univariate analysis, the patients' age, body mass index (BMI), and number of metastatic lymph nodes (LNs) were found to increase the development of lymphedema. In addition, chemotherapy, breast or chest wall radiotherapy, and axillary radiotherapy also played a role. In the multivariate model, BMI (OR=5.491; 95% CI: 1.382-21.82), metastatic LNs (OR=0.314; 95% CI: 0.118-0.839), axillary radiotherapy (OR=15.34; 95% CI: 5.526-42.581), chemotherapy (OR=5.325; 95% CI: 1.48-19.153), and age (OR=1.044; 95% CI: 1.007-1.083) were significantly associated with an increased risk of lymphedema. Conclusion: This study demonstrated that there was a higher lymphedema prevalence ratio of 41.5% in breast cancer patients who underwent level 3 ALND and found that the risk factors for lymphedema development were axillary radiotherapy, chemotherapy, number of metastatic LNs, age, and BMI.