Introduction. Socioeconomic and racial factors have been reported as influencing breast cancer outcomes. Low income and African American race are associated with worse outcomes after a breast cancer diagnosis. Lymphedema is a common side effect of cancer treatment, occurring in approximately 25-60% of patients who undergo axillary dissection with or without radiation. In our urban, heavily African American population, we examined socioeconomic risk factors for arm lymphedema development. Methods. 176 women were enrolled before surgery for stage 0-III breast cancer. Baseline interviews were conducted, including job descriptions, income, ethnic background, marital status, weight, and medical comorbidities. Pathologic stage as well as treatment regimen including receipt of radiation to the axilla were also recorded. Baseline arm measurements were also taken. Arm measurements were repeated at intervals of 3 months up to 2 years, and any increase >5% was classified as lymphedema. Median follow-up was 2 years. Results. Cox regression was used to identify patient factors associated with lymphedema development. Median age at enrollment was 51 (29-86). 46% of patients enrolled were Caucasian, and 42% were African American. 11% had carcinoma in situ, 33% had stage I, 42% had stage II, and 14% had stage III breast cancer at presentation. 68% of patients were overweight or obese at presentation. Of the patients who had income data available, 30% had income >$50,000 per year, 15% had income $15,000-50,000 per year, and 24% of patients had income <$15,000 per year. 45% of patients were married or cohabitating with a partner, 38% were divorced and 13% were single. 20% of patients were not working outside the home at the time of enrollment, 49% had jobs that involved office work, and 23% had jobs that involved manual labor. Job descriptions classified as involving manual labor were associated with higher risk of lymphedema (p=0.033). Higher body mass index (≥30), total mastectomy, and axillary dissection (removal of ≥9 nodes) were significantly associated with development of lymphedema (p<0.05). Divorced status showed a trend towards association with lymphedema but was not statistically significant (p=0.08) Sentinel node biopsy with axillary sampling was not a risk factor for lymphedema development. Race was not associated with lymphedema development. Very low income (United States Housing and Urban Development classification <$15,000 at the time of the study) was not significantly associated with higher risk of lymphedema. Conclusion. Higher body mass index and more extensive surgical intervention are known risk factors for lymphedema development. Our study findings also showed an association between these known risk factors and lymphedema development. There has been conflicting evidence about weight lifting and arm lymphedema development in the past. A previous report from Schmitz et al. in the New England Journal of Medicine showed no association of slowly progressive weight lifting with lymphedema risk. Our study, however, showed a significant association of work-related manual labor with arm lymphedema development. In our urban population of Detroit, Michigan, many manual laborers work in the automotive industry. This type of work may require lifting of heavy loads suddenly, rather than in a controlled, gradual increase as with exercise. Interventions to avoid sudden resumption of manual labor requiring lifting of heavy loads after breast cancer treatment may be beneficial in reducing the risk of lymphedema development.
Citation Format: Lydia Choi, Hadeel Assad, Wei Chen, Tammy Demeere, Hyejeong Jang, Elizabeth Weisberg, Mary Ann Kosir. Arm lymphedema and socioeconomic factors in an urban cancer center [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-22.