Northeastern Society of Plastic Surgeons

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Correlation between Vascular Comorbidities and Socioeconomic Status As Risk Predictors for Breast Cancer Related Lymphedema (BCRL)
Bracha Pollack*, Adana-Christine Campbell, Arielle N. Roberts, Jonathan Rubin, Jinyeon Shin, Gopika Ashokan, Hyeung Ju Park, Raghu Kataru, Babak J. Mehrara
Plastic and Reconstructive Surgery, Memorial Sloan Kettering Sloan Cancer Center, Lawrence, NY

Background:
Breast cancer related lymphedema (BCRL) is the most common cause of secondary lymphedema in developed countries. Previous studies show that cardiovascular co-morbidities increase the risk of BCRL; recent studies show socioeconomic factors also influence disease development. This study analyzes the independent effects of both variables on the risk of BCRL development.
Methods:
We identified breast cancer patients who underwent axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) procedures between 2000 and 2023 with 18 months follow up. Both cardiovascular and socioeconomic variables were collected. Univariable analysis was performed using Chi-squared test or Mann Whitney U test. Multivariable analysis was performed using a multiple logistic regression model.
Results:
Of the 28,863 included patients, 2,306 were diagnosed with BCRL. On univariable analysis, BCRL rate was higher among Black patients (14% vs. 8.5%), Hispanic or Latino patients (8.6% vs. 6.6%), those with Medicaid (4.9% vs. 3.8%) or Medicare insurance (41.5% vs. 39.1%) and in those with diabetes (9.3% vs 6.6%) and hypertension (31.4% vs. 27.7%), while Asian race was protective (5.6% vs. 8.6%).
On multivariable analysis, several socioeconomic risk factors were independently associated with BCRL development, including Black race (OR 1.22, 95% CI 1.0-1.4, p=0.0110), Medicare insurance coverage (OR 1.20, 95% CI 1.1-1.3, p=0.0004), and social deprivation index score (OR 1.002, 95% CI 1-1.004, p=0.0065) with Asian race identified as a protective factor (OR 0.62, 95% CI 0.5-0.8, p<0.0001).
Conclusion:
Our large retrospective study highlights the role of socioeconomic factors in BCRL development and suggests that the increased risk of disease in patients with vascular co-morbidities may be related to socioeconomic factors or complex treatment effects rather than independent effects of these co-morbidities. These findings are important as they raise crucial questions relating to patient care and indicates that access to care is a significant risk factor for BCRL.


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