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Breast Cancer Lymphedema Rates After Modern Axillary Treatments: How Accurate Are Our Estimates?
*Chandler Scott Cortina1, *Carmen Bergom2, *British Fields1, *Morgan A Craft1, Tina W.F. Yen1, *Adam Currey1, *Amanda L Kong1
1Medical College of Wisconsin, Milwaukee, WI;2Washington University School Of Medicine, St. Louis, MO

Objective: Several axillary clinical trials have demonstrated treatment methods to minimize the risk of breast cancer-related lymphedema (BCRL) while preserving regional control. We sought to determine the percent lifetime-risk (PLR) of BCRL that surgeons and radiation oncologists (RO) discuss with patients prior to axillary intervention(s). Methods: A nationwide survey of surgeons and ROs was fielded using the American Society of Breast Surgeons and the the American Society for Radiation Oncology membership databases through a secure online survey from July - August 2020. Physicians who do not treat breast cancer were excluded. Participants were asked to identify what number they use to describe PLR of BCRL after different axillary interventions. Statistical analyses were performed in R (v4.0.2) utilizing unpaired t-tests to compare means between the two populations. Results: 680 surgeons and 324 ROs responded; response rates of 23% and 8.3%, respectively. Mean rates of PLR to develop BCRL by type of axillary intervention(s) and specialty are listed in Table 1. While the estimated rate after sentinel lymph node biopsy (SLNB) was clinically similar between surgeons and ROs, statistically, surgeons quoted a higher PLR (p=0.03). For all other axillary interventions, surgeons estimated clinically and statistically significant higher rates compared to ROs (p<0.001). Table 2 compares our findings with that of objective measures of BCRL. Conclusion: There is notable variability in the estimated PLR of BCRL between surgeons and ROs. These findings highlight the need for physician education on the current evidence of PLR of BCRL in an effort to provide patients with accurate estimates prior to axillary intervention(s).
Table 1. Mean risk of BCRL by axillary intervention(s). P-values based on unpaired t-test:

Axillary Intervention(s)SurgeonsRadiation Oncologistsp-value
MSDMSD
SLNB5.7%4.35.0%3.40.03
ALND21.8%8.617.5%7.7<0.001
SLNB + RNI14.1%7.611.2%5.9<0.001
ALND + RNI34.8%11.726.2%9.6<0.001

M = mean, SD = standard deviation, SLNB=sentinel node biopsy, ALND=axillary dissection, RNI=regional nodal irradiation
Table 2. Comparison of PLR of BCRL by axillary intervention(s) between survey and previous publications:
Study:SLNBALNDSLNB + RNIALND + RNI
Surgeon Survey5.7%21.8%14.1%34.8%
Radiation Oncologist Survey5.0%17.5%11.2%26.2%
Boyages et al.Int J Radiat Oncol Biol Phys 202012.9%25%33.3%30.8%
Naoum et al.J Clin Oncol 20208.0%24.9%10.7%30.1%
Nguyen et al.Ann Surg Oncol 20175.3%15.9%-26.9%
DiSipio et al.Lancet Oncol 20135.6%19.9%--
McLaughlin et al.J Clin Oncol 20085.2%16.4%--
Beaulac et al.JAMA Surg 2002-27.8%--


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