Table 3.

Patient and treatment risk factors for lymphedema. HRs at end of 5 y of follow-up, unadjusted and adjusted for all variables listed in the table

Potential risk factor*ANY lymphedema, n = 238Moderate/severe lymphedema, n = 82
Unadjusted HRs (95% CI)Adjusted HRs (95% CI)Unadjusted HRs (95% CI)Adjusted HRs (95% CI)
Patient characteristics
Age group (reference: <50 y)
    80+0.49 (0.30-0.80)0.79 (0.43-1.46)0.49 (0.22-1.11)1.09 (0.38-3.14)
    50-790.74 (0.56-0.97)0.83 (0.60-1.14)0.56 (0.35-0.88)0.78 (0.45-1.36)
Race (reference: white)
    Black1.45 (1.12-1.88)1.17 (0.87-1.57)2.10 (1.36-3.24)1.39 (0.86-2.25)
BMI (reference: <25)
    30+1.66 (1.23-2.26)1.45 (1.04-2.02)1.79 (1.06-3.02)1.61 (0.91-2.83)
    25-29.991.20 (0.87-1.66)1.24 (0.89,1.74)1.21 (0.69-2.13)1.30 (0.71-2.37)
Education level (reference: college graduate+)
    <High school grad1.72 (1.12-2.62)1.49 (0.92-2.40)2.61 (1.24-5.50)1.84 (0.78-4.32)
    High school grad or some college1.69 (1.19-2.39)1.56 (1.08-2.24)2.02 (1.05-3.86)1.79 (0.91-3.52)
Marital status (reference: unmarried)
    Married1.01 (0.79-1.31)1.03 (0.78-1.36)0.67 (0.43-1.05)0.68 (0.42-1.11)
Health coverage (reference: private insurance)
    Medicaid/public assistance/no insurance2.22 (1.47-3.34)1.46 (0.91-2.32)1.92 (0.97-3.81)0.93 (0.43-2.00)
    Some Medicare0.88 (0.65-1.18)1.00 (0.69-1.44)0.69 (0.41-1.18)0.94 (0.47-1.85)
Difficulty getting care (reference: not at all)
    Extremely/very difficult1.85 (1.03-3.33)1.20 (0.61-2.35)2.91 (1.25-6.79)1.65 (0.61-4.51)
    Somewhat difficult1.44 (1.07-1.94)1.25 (0.91-1.71)1.73 (1.06-2.82)1.52 (0.91-2.54)
Treatments
Lymph node surgery (reference: no lymph node surgery)
    SLNB only1.08 (0.61-1.92)1.04 (0.58-1.88)0.99 (0.31-3.20)0.99 (0.29-3.40)
    Any ALND3.12 (2.20-4.43)2.61 (1.77-3.84)3.96 (1.99-7.86)2.59 (1.17-5.74)
        SLNB and ALND2.89 (1.93-4.30)3.18 (1.48-6.86)
        ALND only3.27 (2.27-4.73)4.46 (2.21-9.02)
Breast surgery (reference: breast conservation)
    Mastectomy1.25 (0.94-1.65)1.11 (0.78-1.58)2.18 (1.40-3.41)1.60 (0.90-2.86)
        Simultaneous reconstruction1.54 (0.96-2.45)2.04 (0.96-4.34)
        No simultaneous reconstruction1.16 (0.85-1.59)2.23 (1.38-3.60)
Chemotherapy (reference: none)
    Anthracycline-based regimen2.11 (1.59-2.79)1.46 (1.04-2.04)5.23 (3.09-8.85)3.76 (2.01-7.04)
    Other/unknown type1.49 (0.89-2.48)1.05 (0.62-1.80)4.37 (1.99-9.56)3.16 (1.38-7.23)
Radiation therapy (reference: none)
    Breast/chest wall only1.02 (0.76-1.38)1.18 (0.80-1.73)0.60 (0.35-1.04)0.89 (0.43-1.81)
    Breast/chest wall + supraclavicular field1.32 (0.60-2.87)0.77 (0.34-1.73)2.13 (0.92-4.93)1.06 (0.44-2.60)
    Breast/chest wall + supraclavicular field + full axilla1.33 (0.66-2.68)0.95 (0.46-1.97)1.72 (0.70-4.18)1.03 (0.40-2.69)
    Breast/chest wall + supraclavicular field (+/− full axilla).1.33 (0.77-2.29)0.86 (0.48-1.54)1.92 (0.98-3.75)1.05 (0.50-2.20)
Tamoxifen (reference: none)
    Yes1.02 (0.76-1.36)1.03 (0.76-1.39)1.15 (0.71-1.87)1.23 (0.73-2.08)
Breast/axillary infection (reference: none)
    Yes1.80 (1.05-3.10)1.15 (0.65-2.03)1.11 (0.40-3.04)0.70 (0.25-1.97)
  • *The numbers of patients in each category can be found in Tables 1 and 2.

  • Seventy-three (89%) of the 82 women with moderate/severe lymphedema had lymphedema lasting 6 or more months.

  • These sublevels were not included in the final model because there were too few observations to permit cross-classification of factors to support estimation and interpretation.