Axillary web syndrome among Chilean women with breast cancer: incidence and possible predisposing factors.

Karol Ramírez-Parada1 & Diana Garay-Acevedo1 & Williams Mella-Abarca1 & Militza Petric-Guajardo2 & César Sánchez-Rojel3 & Margaret L. McNeely4 & Ivana Leao-Ribeiro5 & Rodrigo Fernández-Verdejo6. Supportive Care in Cancer November 2019

Abstract

Axillary web syndrome among Chilean women with breast cancer: incidence and possible predisposing factors

Karol Ramírez-Parada1 & Diana Garay-Acevedo1 & Williams Mella-Abarca1 & Militza Petric-Guajardo2 & César Sánchez-Rojel3 & Margaret L. McNeely4 & Ivana Leao-Ribeiro5 & Rodrigo Fernández-Verdejo6. Supportive Care in Cancer November 2019

Purpose Breast cancer (BC) is the most common cancer in women worldwide. The main treatment for BC is surgery, which involves an axillary procedure that associates with the development of axillary web syndrome (AWS). The incidence of AWS among Chilean women with BC and its possible predisposing factors are currently unknown. Thus, we aimed to (1) determine the incidence of AWS among Chilean women with BC after surgery and (2) identify possible predisposing factors.

Methods Within 90 days post-surgery, patients were assessed for AWS, i.e., palpable or visible axillary cords in the axillary region extending down from the mid-axilla to the ipsilateral arm. We then computed the odds ratio with 95% confidence interval (OR [95% CI]) for havingAWS considering the following predisposing factors: age,bodymass index (BMI), number of lymph nodes removed, axillary procedure, days from surgery to the physicaltherapy assessment, hospital for the surgery, type of breast surgery, and neoadyuvant chemotherapy.

Results AWS was present in 49 out of 107 patients (45.8%). Younger age and lower BMI appeared as the sole predisposing factors for AWS (age, 0.95 [0.91–0.99]; BMI, normal weight 1.00, overweight 0.35 [0.11–1.12], obesity 0.28 [0.08–0.97]). Conclusion The incidence of AWS among Chilean women with BC was 45.8%. Our study also confirms data from previous reports showing that younger age and low BMI are associated with the development of AWS.

Main findings

  • Among the 107 patients studied, the overall incidence of AWS was 45.8%.
  • Patients with AWS were younger and had lower BMI than patients without AWS. The proportion of patients in the normal weight BMI category was 2.6 times higher among those with AWS compared with those without AWS.
  • There were no significant differences between women with and without AWS in the axillary procedure performed, the number of lymph nodes removed, type of breast surgery, neoadjuvant chemotherapy, radiotherapy, pain, shoulder abduction, days from surgery to physical therapy assessment, or the hospital that performed the surgery.
  • They observed that the odds for AWS were 72% lower in patients with obesity compared with those with normal weight.
  • In contrast to previous studies, they did not find a significant association between the method of removal of axillary lymph nodes and AWS.
  • he number of lymph nodes removed did not associate with AWS presence, nor modified the odds for AWS even when adjusted for age and BMI.
  • They found a reduced range of motion (mean 127°), but this was unrelated to the presence of AWS. The reduced shoulder abduction in our patients may be therefore explained by at least two other factors. Firstly, most (~70%) of our patients had axillary lymph node dissection, the most aggressive approach that strongly impairs the shoulder’s range of motion. bSecondly, in Chile, patients with BC are often instructed to reduce arm movements and to avoid lifting weights for life, in order to prevent lymphedema.