Breast cancer related lymphedema in a cohort of Nigerian breast cancer survivors

Abstract

Purpose Breast cancer related lymphedema (BCRL) is a common complication of breast cancer treatment. Despite patients in sub-Saharan Africa being significantly at risk, very limited data exist on the subject in this context. Hence this study. Methods A crossectional study of survivors, at least 6 months post-mastectomy and axillary lymph node dissection (ALND). Lymphedema was diagnosed using multiple techniques: self-report of arm swelling, arm measurement (≥ 2cm difference from contralateral arm), > 10% difference in extracellular water (ECW) using bioimpedance analysis and a lower threshold of 5% to include patients with subclinical lymphedema. With self-report as the reference, the accuracy of the various diagnostic methods was assessed. The relationship between lymphedema and clinical variables was tested using univariate logistic regression analysis. Results Fifty one patients with a median age of 51years and a median duration of 40 months post-surgery (10–62 months) were evaluated. The prevalence of lymphedema was 39.2% based on symptoms, 33% using arm measurements, 22.2% using bioimpedance analysis at a threshold of > 10% difference in ECW and 46.7% at a threshold of 5%. ECW difference of > 5% had the highest sensitivity (65%) while ECW difference at 10% threshold had the highest specificity (89%). Obesity was the only variable associated with lymphedema in this cohort (p = 0.018). Conclusion This is the first series on BCRL among survivors using conventional and contemporary detection techniques in the Nigerian context. The high rate reported in this cohort provides a strong justification to preemptively adopt interventions to either mitigate its occurrence or limit its progression.