Breast cancer-related lymphedema occurs more frequently in black and white women

The highest incidence of lymphedema observed was in black women with a 24-month lymphedema rate of 39.4%.

The results also showed that Hispanic females had a three-fold higher incidence of breast cancer-related lymphedema than Caucasian females. However, Andrea V, Deputy Doctor of Breast Cancer Services in the Department of Surgery at the Memorial Sloan Kettering Cancer Center. Barrio, MD and FACS said more data was needed to confirm this observation.

“Especially, the number of Hispanic females in our study was small,” explained Barrio, the lead author of the study, presenting the data at a press conference.

At the beginning of her presentation, Vario said the results of epidemiological studies show that black women with breast cancer are more likely to develop lymphedema. However, as she argued, there are few positive clinical trial data confirming those results.

“The purpose of our study is to assess the incidence of lymphedema in a prospective cohort of patients treated with axillary lymph node dissection, identify risk factors associated with the development of lymphedema, and develop lymphedema. It was to assess the impact of race and ethnicity on rate and severity. “

To assess this incidence, Vario and her colleagues enrolled 827 women with breast cancer over the age of 18. Enrolled patients also had to undergo unilateral ALND in the primary setting or after sentinel lymph node biopsy to qualify for inclusion in the analysis.

The authors of the study used a perometer to collect measurements on both arms. Patients measured these measurements at baseline, after surgery, and every 6 months for 2 years. A relative increase in arm volume in patients over 10% from baseline indicated the presence of lymphedema.

After considering ineligible criteria, the final study enrollment consisted of 276 patients (median age 48 years, range 40-57 years) who underwent at least one longitudinal measurement after baseline. rice field.

More than half (60%) of the patient population was Caucasian. The rest of the patient population consisted of 20% black, 11% Asian, and 6% Hispanic. In addition, 68% of the patient population participated in the HR + / HER2-disease study. 19% of patients were diagnosed with HER2 + disease and 13% of the population had HR- / HER2- disease. 70% of the study population received neoadjuvant chemotherapy and the rest under prior surgery. Barrio explained that almost all patients (94%) who underwent prior surgery and received systemic chemotherapy received a regimen containing taxanes.

Treatment features also showed that 95% of patients received radiation therapy and 93% received lymph node RT.

When assessing clinical characteristics by race and ethnicity, white and black women were older (median age 49 years each). Black (30.3 kg / m2) and Hispanic (28.1 kg / m2) patients had a higher baseline BMI compared to the Caucasian (25.2 kg / m2) and Asian (22.2 kg / m2) patient populations.

With a median follow-up of 22.6 months, 56 patients developed lymphedema. The results show that the 12-month lymphedema rate is 8.8% (95% CI; 5.9-13) and the 24-month lymphedema rate is 24.7% (95% CI; 19.2-31.5%). I did.

Barrio said that the highest incidence of lymphedema observed was in black women with a 24-month lymphedema rate of 39.4%. The percentage was compared to 27.7% for Hispanic females, 23.4% for Asian females, and 20.5% for Caucasian females.

The results also showed that receipt of neoadjuvant chemotherapy was associated with a higher 24-month lymphedema rate compared to previous surgery at 30.9% vs 11.1% ().NS = .0066).

Black women had the highest incidence of lymphedema, with a 24-month lymphedema rate of 39%, but 28% for Hispanic women, 23% for Asian females, and 21% for Caucasian females. ..

Notably, Barrio said that among women with lymphedema, the severity of lymphedema did not change between racial and ethnic groups, and similar relative volume changes were observed.

“After adjusting for other variables, we observed a higher incidence of lymphedema in black women treated with axillary lymph node dissection and radiation therapy. Similar findings were observed in Hispanic women. But we need to check with a larger dataset, “she said.

Barrio also emphasized how preoperative chemotherapy is associated with a significant increase in lymphedema compared to adjuvant therapy in women who received ALND and RT.

As a result, Vario concludes:

“A subset of patients who are unlikely to achieve a complete pathological response to lymph nodes with neoadjuvant chemotherapy need an alternative to NAC to avoid ALND. Increased incidence of lymphedema and black women. Little is known about the cause, but it may be due to racial differences, inflammatory reactions, tissue fibrosis, or lymphatic function. Future studies will be behind racial disparities in the development of lymphedema. We need to work on biological mechanisms. “

reference

1. Barrio AV, et al. Racial and ethnic effects on the incidence and severity of breast cancer-related lymphedema after axillary lymph node dissection: results of a prospective screening study. Announcement location: 2021 San Antonio Breast Cancer Symposium; December 7-10, 2021; Virtual. Abstract GS4-01