Journal ArticleDOI
Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis
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TLDR
It is suggested that more than one in five women who survive breast cancer will develop arm lymphoedema and a clear need exists for improved understanding of contributing risk factors, as well as of prevention and management strategies to reduce the individual and public health burden of this disabling and distressing disorder.Abstract:
Summary Background The body of evidence related to breast-cancer-related lymphoedema incidence and risk factors has substantially grown and improved in quality over the past decade. We assessed the incidence of unilateral arm lymphoedema after breast cancer and explored the evidence available for lymphoedema risk factors. Methods We searched Academic Search Elite, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials (clinical trials), and Medline for research articles that assessed the incidence or prevalence of, or risk factors for, arm lymphoedema after breast cancer, published between Jan 1, 2000, and June 30, 2012. We extracted incidence data and calculated corresponding exact binomial 95% CIs. We used random effects models to calculate a pooled overall estimate of lymphoedema incidence, with subgroup analyses to assess the effect of different study designs, countries of study origin, diagnostic methods, time since diagnosis, and extent of axillary surgery. We assessed risk factors and collated them into four levels of evidence, depending on consistency of findings and quality and quantity of studies contributing to findings. Findings 72 studies met the inclusion criteria for the assessment of lymphoedema incidence, giving a pooled estimate of 16·6% (95% CI 13·6–20·2). Our estimate was 21·4% (14·9–29·8) when restricted to data from prospective cohort studies (30 studies). The incidence of arm lymphoedema seemed to increase up to 2 years after diagnosis or surgery of breast cancer (24 studies with time since diagnosis or surgery of 12 to Interpretation Our findings suggest that more than one in five women who survive breast cancer will develop arm lymphoedema. A clear need exists for improved understanding of contributing risk factors, as well as of prevention and management strategies to reduce the individual and public health burden of this disabling and distressing disorder. Funding The National Breast Cancer Foundation, Australia.read more
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References
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Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.
Sue Duval,Richard L. Tweedie +1 more
TL;DR: In this paper, a rank-based data augmentation technique is proposed for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome.
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A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer.
Umberto Veronesi,Giovanni Paganelli,Giuseppe Viale,Alberto Luini,Stefano Zurrida,Viviana Galimberti,Mattia Intra,Paolo Veronesi,Chris Robertson,Patrick Maisonneuve,Giuseppe Renne,Concetta De Cicco,Francesca De Lucia,R. Gennari +13 more
TL;DR: Sentinel-node biopsy is a safe and accurate method of screening the axillary nodes for metastasis in women with a small breast cancer.
A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer
Umberto Veronesi,Giovanni Paganelli,Giuseppe Viale,Alberto Luini,S. Zurrida,Viviana Galimberti,Mattia Intra,Paolo Veronesi,Chris Robertson,Patrick Maisonneuve,Giuseppe Renne,C. De Cicco,F. De Lucia,R. Gennari +13 more